Nokea
A client is diagnosed with osteomyelitis. This is most commonly caused by which of the following?
- A. Proteus vulgaris
- B. Pseudomonas aeruginosa
- C. Escherichia coli
- D. Staphylococcus aureus
Correct Answer: D
Rationale: Staphylococcus aureus causes over 50% of bone infections. Other organisms include Proteus vulgaris and Pseudomonas aeruginosa, as well as E. coli.
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A client is taking large amounts of salicylates for the treatment of bursitis of the left shoulder. The client should be aware to report which symptoms of salicylism?
- A. Ringing in the ears
- B. Diarrhea
- C. Dry hacking cough
- D. Dry eyes
Correct Answer: A
Rationale: Signs of salicylate toxicity include headache, nausea, vomiting, tinnitus, increased pulse and respiratory rate, fever, mental confusion, and drowsiness. Dry hacking cough, diarrhea, and dry eyes are not symptoms of salicylate toxicity.
A client calls the clinic and reports having been bitten by a tick and expresses worry about Lyme disease. How long does the nurse understand that the tick must be attached to transmit infection?
- A. 1 to 2 hours
- B. 12 to 24 hours
- C. 24 to 36 hours
- D. 36 to 48 hours
Correct Answer: D
Rationale: For the client to have Lyme disease, the tick must be attached for 36 to 48 hours. Removing a tick as early as possible may prevent infection. The other times given are not long enough to transmit infection.
A client diagnosed with degenerative joint disease of the fingers reports now having bumps on the fingers that do not hurt. The nurse observes bony nodules on the distal interphalangeal joints. What type of 'bumps' does the nurse understand these are?
- A. Rheumatoid nodules
- B. Tophi
- C. Bouchard nodes
- D. Heberden nodes
Correct Answer: D
Rationale: DJD affects the hands; the fingers frequently develop painless bony nodules on the dorsolateral surface of the interphalangeal joints. Heberden nodes are bony enlargement of the distal interphalangeal joints. Bouchard nodes are bony enlargement of the proximal interphalangeal joints. Rheumatoid nodules are associated with rheumatoid arthritis. Tophi occur with gout and elevated uric acid levels.
A client suffered a significant ankle fracture several months ago. Which indicator would the nurse use to determine that the client is exhibiting signs and symptoms of chronic osteomyelitis?
- A. High fever
- B. Persistent draining sinus
- C. Rapid pulse
- D. Tenderness over the affected area
Correct Answer: B
Rationale: Persistent draining sinus indicates a chronic infection in a client with osteomyelitis. This is the symptom the nurse would use to differentiate between an acute and chronic infection. High fever, rapid pulse, and tenderness or pain over the affected area is evidence of an acute infection.
The nurse is discussing the new medication that a client will be taking for treatment of rheumatoid arthritis. Which disease-modifying antirheumatic drug (DMARD) will the nurse educate the client about?
- A. Methotrexate
- B. Celecoxib
- C. Methylprednisolone
- D. Mercaptopurine azathioprine
Correct Answer: A
Rationale: Methotrexate is a DMARD that reduces the amount of joint damage and slows the damage to other tissues as well. Celecoxib is a nonsteroidal anti-inflammatory drug (NSAID). Methylprednisolone is a steroid to reduce pain and inflammation and slow joint destruction. Mercaptopurine azathioprine is a cytotoxic drug.