NCLEX Osteomyelitis Exam II

The nurse is taking an initial history of a new client with a musculoskeletal problem. Which factor is most important for the nurse to keep in mind for this assessment? Client's age Client's lifestyle Any chronic disorder or recent injury Duration and location of discomfort or pain

Any chronic disorder or recent injury Yes, the other factors are important, but a CHRONIC DISORDER IS MOST IMPORTANT!

A client has undergone arthroscopy. After the procedure, the site where the arthroscope was inserted is covered with a bulky dressing. The client's entire leg is also elevated without flexing the knee. What is the appropriate nursing intervention required in caring for a client who has undergone arthroscopy? Apply a cold pack at the insertion site. Apply warm compresses to the insertion site. Provide a gentle massage. Assist with performing ROM exercises.

Apply a cold pack at the insertion site. Explanation: After covering the arthroscope insertion site with a bulky dressing and elevating the client's entire leg, the nurse needs to apply a cold pack at the site to minimize any chances of swelling

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

Chills HINT: It definitely cannot be hypothermia because infection=fever.

The nurse is caring for a client who underwent a total hip replacement yesterday. What should the nurse do to prevent dislocation of the new prosthesis? Keep the affected leg in a position of adduction. Have the client reposition himself independently. Protect the affected leg from internal rotation. Keep the hip flexed by placing pillows under the client's knee.

Protect the affected leg from internal rotation. Explanation: Abduction of the hip helps to prevent dislocation of a new hip joint. Rotation and adduction should be avoided. While the hip may be flexed slightly, it shouldn't exceed 90 degrees and maintenance of flexion isn't necessary. The client may not be capable of safe independent repositioning at this early stage of recovery.

A client undergoes an invasive joint examination of the knee. What will the nurse closely monitor the client for? Lack of sleep and appetite Serous drainage Signs of depression Signs of shock

Serous drainage Explanation: When the client undergoes an invasive knee joint examination, the nurse should inspect the knee area for swelling, bleeding, and serous drainage. An invasive joint examination does not cause lack of sleep or appetite, depression, or shock. The client may be in shock due to the injury itself

Which device is designed specifically to support and immobilize a body part in a desired position? Brace Sling Splint Traction

Splint

The nurse assesses soft subcutaneous nodules along the line of the tendons in a patient's hand and wrist. What does this finding indicate to the nurse? The patient has osteoarthritis. The patient has lupus erythematosus. The patient has rheumatoid arthritis. The patient has neurofibromatosis.

The patient has rheumatoid arthritis. Explanation: The subcutaneous nodules of rheumatoid arthritis are soft and occur within and along tendons that provide extensor function to the joints. Osteoarthritic nodules are hard and painless and represent bony overgrowth that has resulted from destruction of the cartilaginous surface of bone within the joint capsule. Lupus and neurofibromatosis are not associated with the production of nodules.

A client with a recent left above-the-knee amputation states, "I can feel pain in my left toes." Which is the best response by the nurse? "Your left toes have been amputated." "The pain is really from the nerves in the upper leg." "Pain medication usually does not help this type of pain." "Describe the pain and rate it on the pain scale."

"Describe the pain and rate it on the pain scale." PHANTOM PAIN IS REALLL!!

A 67-year-old patient is receiving IV antibiotics at home to treat chronic osteomyelitis of the left femur. The nurse chooses a nursing diagnosis of ineffective health maintenance when the nurse finds that the patient a. is frustrated with the length of treatment required. b. takes and records the oral temperature twice a day. c. is unable to plantar flex the foot on the affected side. d. uses crutches to avoid weight bearing on the affected leg.

ANS: C Foot drop is an indication that the foot is not being supported in a neutral position by a splint. Using crutches and monitoring the oral temperature are appropriate self-care activities. Frustration with the length of treatment is not an indicator of ineffective health maintenance of the osteomyelitis

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."

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

A patient with acute osteomyelitis of the left femur is hospitalized for regional antibiotic irrigation. Which intervention will be included in the initial plan of care? a. Immobilization of the left leg b. Positioning the left leg in flexion c. Assisted weight-bearing ambulation d. Quadriceps-setting exercise repetitions

ANS: A Immobilization of the affected leg helps decrease pain and reduce the risk for pathologic fractures. Weight-bearing exercise increases the risk for pathologic fractures. Flexion of the affected limb is avoided to prevent contractures

Which nursing action included in the care of a patient after laminectomy can the nurse delegate to experienced unlicensed assistive personnel (UAP)? a. Check ability to plantar and dorsiflex the foot. b. Determine the patient's readiness to ambulate. c. Log roll the patient from side to side every 2 hours. d. Ask about pain control with the patient-controlled analgesia (PCA).

ANS: C Repositioning a patient is included in the education and scope of practice of UAP, and experienced UAP will be familiar with how to maintain alignment in the postoperative patient. Evaluation of the effectiveness of pain medications, assessment of neurologic function, and evaluation of a patient's readiness to ambulate after surgery require higher level nursing education and scope of practice

The nurse should reposition the patient who has just had a laminectomy and diskectomy by a. instructing the patient to move the legs before turning the rest of the body. b. having the patient turn by grasping the side rails and pulling the shoulders over. c. placing a pillow between the patient's legs and turning the entire body as a unit. d. turning the patient's head and shoulders first, followed by the hips, legs, and feet.

ANS: C The spine should be kept in correct alignment after laminectomy. The other positions will create misalignment of the spine

Which assessment finding for a patient who has had a surgical reduction of an open fracture of the right radius is most important to report to the health care provider? a. Serous wound drainage b. Right arm muscle spasms c. Right arm pain with movement d. Temperature 101.4° F (38.6° C)

ANS: D An elevated temperature is suggestive of possible osteomyelitis. The other clinical manifestations are typical after a repair of an open fracture

A nurse is caring for a client placed in traction to treat a fractured femur. Which nursing intervention has the highest priority? Assessing the extremity for neurovascular integrity Keeping the client from sliding to the foot of the bed Keeping the ropes over the center of the pulley Ensuring that the weights hang free at all times

Assessing the extremity for neurovascular integrity Explanation: Although all measures are correct, assessing neurovascular integrity takes priority because a decrease in neurovascular integrity could compromise the limb. The pull of the traction must be continuous to keep the client from sliding. Sufficient countertraction must be maintained at all times by keeping the ropes over the center of the pulley. The line of pull is maintained by allowing the weights to hang free.

A client with diabetes punctured the foot with a sharp object. Within a week, the client developed osteomyelitis of the foot. The client was admitted for IV antibiotic therapy. How long does the nurse anticipate the client will receive IV antibiotics? 6 months 3 months 7 to 10 days At least 4 weeks

At least 4 weeks Explanation: Identification of the causative organism to initiate appropriate and ongoing antibiotic therapy for infection control. IV antibiotic therapy is administered for at least 4 weeks, followed by another 2 weeks (or more) of IV antibiotics or oral antibiotics.

A group of students is reviewing information about cast composition in preparation for a discussion on the advantages and disadvantages of each. The students demonstrate understanding of the topic when they cite which of the following as an advantage of a plaster cast? Better molding to the client Quicker drying Longer lasting More breathable

Better molding to the client

The nurse is assisting with the application of a cast. What will the nurse expect to be done first? Covering the skin with a stockinette. Applying strips of the cast material evenly. Arranging for an x-ray to check bone alignment. Cleaning the skin surface.

Cleaning the skin surface. When a cast is to be applied, the skin surface of the area to be casted is cleaned and dried. Then the skin is covered with a stockinette, the limb is padded, and rolls or strips of the casting material are applied evenly. Once the cast is applied, an x-ray is done to check bone alignment.

Which is a circulatory indicator of peripheral neurovascular dysfunction? Weakness Paresthesia Cool skin Paralysis

Cool skin HINT: CIRCULATORY!! Indicators of peripheral neurovascular dysfunction related to circulation include pale, cyanotic, or mottled skin with a cool temperature. The capillary refill is more than 3 seconds. Weakness and paralysis are related to motion. Paresthesia is related to sensation.

The client diagnosed with osteosarcoma is scheduled for a surgical amputation. Which nursing diagnosis would be a priority for this client compared with other surgical clients? Inadequate nutrition Impaired physical mobility Risk for infection Disturbed body image

Disturbed body image Explanation: Amputation of a body part can result in disturbances in body image.

A nurse is caring for a client who has suffered a hip fracture and who will require an extended hospital stay. The nurse should ensure that the client does what action to prevent common complications associated with a hip fracture? Avoid requesting analgesia unless pain becomes unbearable. Use supplementary oxygen when transferring or mobilizing. Increase fluid intake and perform prescribed foot exercises. Remain on bed rest for 14 days or until instructed by the orthopedic surgeon.

Increase fluid intake and perform prescribed foot exercises. Explanation: Deep vein thrombosis (DVT) is among the most common complications related to a hip fracture. To prevent DVT, the nurse encourages intake of fluids and ankle and foot exercises. The client should not be told to endure pain; a proactive approach to pain control should be adopted. While respiratory complications commonly include atelectasis and pneumonia, the use of deep-breathing exercises, changes in position at least every 2 hours, and the use of incentive spirometry help prevent the respiratory complications more than using supplementary oxygen. Bed rest may be indicated in the short term, but is not normally required for 14 days.

A client has an exaggerated convex curvature of the thoracic spine. What is this condition called? kyphosis lordosis scoliosis diaphysis

kyphosis Explanation: Kyphosis is an exaggerated convex curvature of the thoracic spine. Lordosis is an excessive concave curvature of the lumbar spine. Scoliosis is a lateral curvature of the spine. Diaphyses are the long shafts of bones in the arms and legs

A patient tells the nurse, "I was working out and lifting weights and now that I have stopped, I am flabby and my muscles have gone!" What is the best response by the nurse? "While you are lifting weights, endorphins are released, creating increase in muscle mass, but if the muscles are not used they will atrophy." "The muscle mass has decreased from the lack of calcium in the cells." "Your muscles were in a state of hypertrophy from the weight lifting but it will persist only if the exercise is continued." "Once you stop exercising, the contraction of the muscle does not regain its strength."

"Your muscles were in a state of hypertrophy from the weight lifting but it will persist only if the exercise is continued." Explanation: Muscles need to exercise to maintain function and strength. When a muscle repeatedly develops maximum or close to maximum tension over a long time, as in regular exercise with weights, the cross-sectional area of the muscle increases. This enlargement, known as hypertrophy, results from an increase in the size of individual muscle fibers without an increase in their number. Hypertrophy persists only if the exercise is continued

In which order will the nurse implement these collaborative interventions prescribed for a patient being admitted who has acute osteomyelitis with a temperature of 101.2° F? (Put a comma and a space between each answer choice [A, B, C, D].) a. Obtain blood cultures from two sites. b. Send to radiology for computed tomography (CT) scan of right leg. c. Administer gentamicin (Garamycin) 60 mg IV. d. Administer acetaminophen (Tylenol) now and every 4 hours PRN for fever

ANS: A, C, D, B The highest priority for possible osteomyelitis is initiation of antibiotic therapy, but cultures should be obtained before administration of antibiotics. Addressing the discomfort of the fever is the next highest priority. Because the purpose of the CT scan is to determine the extent of the infection, it can be done last

Which actions will the nurse include in the plan of care when caring for a patient with metastatic bone cancer of the left femur (select all that apply)? a. Monitor serum calcium level. b. Teach about the need for strict bed rest. c. Avoid use of sustained-release opioids for pain. d. Support the left leg when repositioning the patient. e. Support family as they discuss the prognosis of patient

ANS: A, D, E The nurse will monitor for hypercalcemia caused by bone decalcification. Support of the leg helps reduce the risk for pathologic fractures. Although the patient may be reluctant to exercise, activity is important to maintain function and avoid the complications associated with immobility. Adequate pain medication, including sustained-release and rapidly acting opioids, is needed for the severe pain that is frequently associated with bone cancer. The prognosis for metastatic bone cancer is poor so the patient and family need to be supported as they deal with the reality of the situation.

Which action will the nurse take first when a patient is seen in the outpatient clinic with neck pain? a. Provide information about therapeutic neck exercises. b. Ask about numbness or tingling of the hands and arms. c. Suggest that the patient alternate the use of heat and cold to the neck to treat the pain. d. Teach about the use of nonsteroidal antiinflammatory drugs such as ibuprofen (Advil).

ANS: B The nurse's initial action should be further assessment of the pain because cervical nerve root compression will require different treatment than musculoskeletal neck pain. The other actions may also be appropriate, depending on the assessment findings.

A 50-year-old patient is being discharged after a week of IV antibiotic therapy for acute osteomyelitis in the right leg. Which information will be included in the discharge teaching? a. How to apply warm packs to the leg to reduce pain b. How to monitor and care for the long-term IV catheter c. The need for daily aerobic exercise to help maintain muscle strength d. The reason for taking oral antibiotics for 7 to 10 days after discharge

ANS: B The patient will be on IV antibiotics for several months, and the patient will need to recognize signs of infection at the IV site and how to care for the catheter during daily activities such as bathing. IV antibiotics rather than oral antibiotics are used for acute osteomyelitis. Patients are instructed to avoid exercise and heat application because these will increase swelling and the risk for spreading infection

Following laminectomy with a spinal fusion to treat a herniated disc, a patient reports numbness and tingling of the right lower leg. The first action that the nurse should take is to a. report the patient's complaint to the surgeon. b. check the chart for preoperative assessment data. c. check the vital signs for indications of hemorrhage. d. turn the patient to the side to relieve pressure on the right leg.

ANS: B The postoperative movement and sensation of the extremities should be unchanged (or improved) from the preoperative assessment. If the numbness and tingling are new, this information should be immediately reported to the surgeon. Numbness and tingling are not symptoms associated with hemorrhage at the site. Turning the patient will not relieve the numbness

A nurse who works on the orthopedic unit has just received the change-of-shift report. Which patient should the nurse assess first? a. Patient who reports foot pain after hammertoe surgery b. Patient with low back pain and a positive straight-leg-raise test c. Patient who has not voided 10 hours after having a laminectomy d. Patient with osteomyelitis who has a temperature of 100.5° F (38.1° C)

ANS: C Difficulty in voiding may indicate damage to the spinal nerves and should be assessed and reported to the surgeon immediately. The information about the other patients is consistent with their diagnoses. The nurse will need to assess them as quickly as possible, but the information about them does not indicate a need for immediate intervention