Nokea
A client with suspected osteomalacia has a fractured tibia and fibula. What test would give a definitive diagnosis of osteomalacia?
- A. A bone biopsy
- B. Demineralization of the bone
- C. Increased and decreased areas of bone metabolism
- D. Elevated levels of alkaline phosphatase
Correct Answer: A
Rationale: A definitive diagnosis is obtained by bone biopsy. Radiographic studies demonstrate demineralization of the bone. A bone scan detects increased and decreased areas of bone metabolism. Alkaline phosphatase levels are detected from a blood sample.
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The nurse is assisting a client with removing shoes prior to an examination and observes that the client has a flexion deformity of several toes on both feet of the proximal interphalangeal (PIP) joints. What can the nurse encourage the client to do?
- A. Bind the toes so that they will straighten.
- B. Do active range of motion on the toes.
- C. Have surgery to fix them.
- D. Wear properly fitting shoes.
Correct Answer: D
Rationale: Hammer toe is a flexion deformity of the PIP joint and may involve several toes and may result from wearing poorly fitting shoes. They will not straighten by binding the toes or doing active range of motion exercises. Surgery is an option but should be discussed with an orthopedic surgeon or podiatrist.
The nurse is conducting a new-patient assessment on a patient who reports having fibromyalgia. Which of the following would the nurse expect to assess as the most common finding associated with this condition?
- A. Heberden nodes
- B. Jaw locking
- C. Widespread chronic pain
- D. Butterfly facial rash
Correct Answer: C
Rationale: The most common finding associated with fibromyalgia is widespread and chronic pain, as clients experience an increased sensitivity to pain signals. Heberden nodes are associated with osteoarthritis. Jaw locking is a manifestation of temporomandibular joint dislocation. A butterfly facial rash is associated with systemic lupus erythematosus.
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?
- A. 6 months
- B. 7 to 10 days
- C. 2 to 3 weeks
- D. At least 4 weeks
Correct Answer: D
Rationale: 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 client is complaining of severe pain in the left great toe. What lab studies that the nurse reviews indicate that the client may have gout?
- A. Elevated white blood count
- B. Elevated uric acid levels
- C. Decreased hemoglobin and hematocrit
- D. Increased AST and ALT
Correct Answer: B
Rationale: Gout is characterized by hyperuricemia (accumulation of uric acid in the blood) caused by alterations in uric acid production, excretion, or both. An elevated white blood count may indicate bleeding from somewhere in the body. Increased AST and ALT would indicate liver dysfunction.
The nurse is planning care in the home for a client with rheumatoid arthritis. What instruction(s) should the nurse include in the plan of care? Select all that apply.
- A. Collaborate with occupational therapists for specialized equipment.
- B. Identify the exercise regimen planned by physical therapist.
- C. Provide nursing assistance for ADLs.
- D. Teach the nursing assistant to allow extra time in the evening for hygiene or other procedures.
- E. Ensure the home environment is safe.
Correct Answer: A,B,C,E
Rationale: The nurse should collaborate with occupational therapists for specialized equipment, identify the exercise regimen planned by physical therapist, provide nursing assistance for ADLs, and ensure the home environment is safe. The nurse should teach the nursing assistant to allow extra time in the morning, not the evening, for hygiene or other procedures.