Lewis Ch64 Musculoskeletal Problems

A patient with osteomyelitis is to receive vancomycin (Vancocin) 500 mg IV every 6 hours. The vancomycin is diluted in 100 mL of normal saline and needs to be administered over 1 hour. The nurse will set the IV pump for how many mL/minute?

1.67. To administer 100 mL in 60 minutes, the IV pump will need to provide 1.67 mL/minute.

Which information will the nurse include when teaching a patient with acute low back pain (select all that apply)?

Acute back pain usually starts to improve within 2 weeks.

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 A. Immobilization of the affected leg helps decrease pain and reduce the risk for pathologic fractures.

Which actions will the nurse include in the plan of care when caring for a patient with metastatic bone cancer of the left femur ?

a. Monitor serum calcium level. d. Support the left leg when repositioning the patient. e. Support family as they discuss the prognosis of patient The nurse will monitor for hypercalcemia caused by bone decalcification. Support of the leg helps reduce the risk for pathologic fractures.

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?

a. Obtain blood cultures from two sites. c. Administer gentamicin (Garamycin) 60 mg IV. d. Administer acetaminophen (Tylenol) now and every 4 hours PRN for fever. b. Send to radiology for computed tomography (CT) scan of right leg. The highest priority for possible osteomyelitis is initiation of antibiotic therapy, but cultures should be obtained before administration of antibiotics.

Which action will the nurse take when caring for a patient with osteomalacia?

a. Teach about the use of vitamin D supplements. Osteomalacia is caused by inadequate intake or absorption of vitamin D.

An assessment finding for a 55-year-old patient that alerts the nurse to the presence of osteoporosis is

a. a measurable loss of height. Osteoporosis occurring in the vertebrae produces a gradual loss of height.

The nurse evaluating effectiveness of prescribed calcitonin (Cibacalcin) and ibandronate (Boniva) for a patient with Paget's disease will consider the patient's

a. pain level. A. Bone pain is one of the common early manifestations of Paget's disease, & the nurse should assess the pain level to determine whether the treatment is effective.

The nurse instructs a patient who has osteosarcoma of the tibia about a scheduled above-the-knee amputation. Which statement by a patient indicates that additional patient teaching is needed?

b. "I did not have this bone cancer until my leg broke a week ago." B. Osteogenic sarcoma may be diagnosed following a fracture, but it is not caused by the injury.

A 39-year-old patient whose work involves frequent lifting has a history of chronic back pain. After the nurse has taught the patient about correct body mechanics, which patient statement indicates that the teaching has been effective?

b. "I will begin doing exercises to strengthen the muscles of my back." B. Exercises can help strengthen the muscles that support the back.

Which action will the nurse take first when a patient is seen in the outpatient clinic with neck pain?

b. Ask about numbness or tingling of the hands and arms. 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.

A 23-year-old patient with a history of muscular dystrophy is hospitalized with pneumonia. Which nursing action will be included in the plan of care?

b. Assist the patient with ambulation. B. Because the goal for the patient with muscular dystrophy is to keep the patient active for as long as possible, assisting the patient to ambulate will be part of the care plan.

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?

b. How to monitor and care for the long-term IV catheter 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.

Which action should the nurse take before administering gentamicin (Garamycin) to a patient who has acute osteomyelitis?

b. Review the patient's creatinine level. B. Gentamicin is nephrotoxic and can cause renal failure.

When administering alendronate (Fosamax) to a patient with osteoporosis, the nurse will

b. assist the patient to sit up at the bedside. To avoid esophageal erosions, the patient taking bisphosphonates should be upright for at least 30 minutes after medication. Fosamax should be taken on an empty stomach, not after taking other medications or eating.

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

b. check the chart for preoperative assessment data. The postoperative movement and sensation of the extremities should be unchanged (or improved) from the preoperative assessment.

Which nursing action included in the care of a patient after laminectomy can the nurse delegate to experienced unlicensed assistive personnel (UAP)?

c. Log roll the patient from side to side every 2 hours. C. Repositioning a patient is included in the education and scope of practice of UAP, & experienced UAP will be familiar with how to maintain alignment in the postoperative patient.

A nurse who works on the orthopedic unit has just received the change-of-shift report. Which patient should the nurse assess first?

c. Patient who has not voided 10 hours after having a laminectomy C. Difficulty in voiding may indicate damage to the spinal nerves and should be assessed and reported to the surgeon immediately.

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

c. is unable to plantar flex the foot on the affected side. Foot drop is an indication that the foot is not being supported in a neutral position by a splint.

An appropriate nursing intervention for a patient who has acute low back pain and muscle spasms is to teach the patient to

c. keep the head elevated slightly and flex the knees when resting in bed. C. Resting with the head elevated and knees flexed will reduce the strain on the back and decrease muscle spasms.

The nurse should reposition the patient who has just had a laminectomy and diskectomy by

c. placing a pillow between the patient's legs and turning the entire body as a unit. C. The spine should be kept in correct alignment after laminectomy.

Which menu choice by a patient with osteoporosis indicates that the nurse's teaching about appropriate diet has been effective?

d. Oatmeal with skim milk and fruit yogurt D. Skim milk and yogurt are high in calcium.

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?

d. Temperature 101.4° F (38.6° C) D. An elevated temperature is suggestive of possible osteomyelitis.

A 54-year-old woman who recently reached menopause and has a family history of osteoporosis is diagnosed with osteopenia following densitometry testing. In teaching the woman about her osteoporosis, the nurse explains that

d. calcium loss from bones can be slowed by increasing calcium intake and weight-bearing exercise. Progression of osteoporosis can be slowed by increasing calcium intake and weight-bearing exercise.

The nurse will determine that more teaching is needed if a patient with discomfort from a bunion says, "I will

d. only wear sandals, no closed-toe shoes." The patient can wear shoes that have a wide forefoot. The other patient statements indicate that the teaching has been effective.