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A nurse is caring for a patient who is 12 hours postoperative following foot surgery. The nurse assesses the presence of edema in the foot. What nursing measure will the nurse implement to control the edema?
- A. Elevate the foot on several pillows.
- B. Apply warm compresses intermittently to the surgical area.
- C. Administer a loop diuretic as ordered.
- D. Increase circulation through frequent ambulation.
Correct Answer: A
Rationale: To control the edema in the foot of a patient who experienced foot surgery, the nurse will elevate the foot on several pillows when the patient is sitting or lying. Diuretic therapy is not an appropriate intervention for edema related to inflammation. Intermittent ice packs should be applied to the surgical area during the first 24 to 48 hours after surgery to control edema and provide some pain relief. Ambulation will gradually be resumed based on the guidelines provided by the surgeon.
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A nurse is caring for a patient who is being assessed following complaints of severe and persistent low back pain. The patient is scheduled for diagnostic testing in the morning. Which of the following are appropriate diagnostic tests for assessing low back pain?
- A. Computed tomography (CT)
- B. Angiography
- C. Magnetic resonance imaging (MRI)
- D. Ultrasound
- E. X-ray
Correct Answer: A,C,D,E
Rationale: A variety of diagnostic tests can be used to address lower back pain, including CT, MRI, ultrasound, and X-rays. Angiography is not related to the etiology of back pain.
Which of the following patients should the nurse recognize as being at the highest risk for the development of osteomyelitis?
- A. A middle-age adult who takes ibuprofen daily for rheumatoid arthritis
- B. An elderly patient with an infected pressure ulcer in the sacral area
- C. A 17-year-old football player who had orthopedic surgery 6 weeks prior
- D. An infant diagnosed with jaundice
Correct Answer: B
Rationale: Patients who are at high risk of osteomyelitis include those who are poorly nourished, elderly, and obese. The elderly patient with an infected sacral pressure ulcer is at the greatest risk for the development of osteomyelitis, as this patient has two risk factors: age and the presence of a soft-tissue infection that has the potential to extend into the bone. The patient with rheumatoid arthritis has one risk factor and the infant with jaundice has no identifiable risk factors. The patient 6 weeks postsurgery is beyond the usual window of time for the development of a postoperative surgical wound infection.
A patient with diabetes has been diagnosed with osteomyelitis. The nurse notes that the patient's right foot is pale and mottled, cool to touch, with a capillary refill of greater than 3 seconds. The nurse should suspect what type of osteomyelitis?
- A. Hematogenous osteomyelitis
- B. Osteomyelitis with vascular insufficiency
- C. Contiguous-focus osteomyelitis
- D. Osteomyelitis with muscular deterioration
Correct Answer: B
Rationale: Osteomyelitis is classified as hematogenous osteomyelitis (i.e., due to blood-borne spread of infection); contiguous-focus osteomyelitis, from contamination from bone surgery, open fracture, or traumatic injury (e.g., gunshot wound); and osteomyelitis with vascular insufficiency, seen most commonly among patients with diabetes and peripheral vascular disease, most commonly affecting the feet. Osteomyelitis with muscular deterioration does not exist.
A nurse is planning the care of an older adult patient with osteomalacia. What action should the nurse recommend in order to promote vitamin D synthesis?
- A. Ensuring adequate exposure to sunlight
- B. Eating a low-purine diet
- C. Performing cardiovascular exercise while avoiding weight-bearing exercises
- D. Taking thyroid supplements as ordered
Correct Answer: A
Rationale: Because sunlight is necessary for synthesizing vitamin D, patients should be encouraged to spend some time in the sun. A low-purine diet is not a relevant action and thyroid supplements do not directly affect bone function. Action must be taken to prevent fractures, but weight-bearing exercise within safe parameters is not necessarily contraindicated.
A nursing educator is reviewing the risk factors for osteoporosis with a group of recent graduates. What risk factor of the following should the educator describe?
- A. Recurrent infections and prolonged use of NSAIDs
- B. High alcohol intake and low body mass index
- C. Small frame, female gender, and Caucasian ethnicity
- D. Male gender, diabetes, and high protein intake
Correct Answer: C
Rationale: Small-framed, nonobese Caucasian women are at greatest risk for osteoporosis. Diabetes, high protein intake, alcohol use, and infections are not among the most salient risk factors for osteoporosis.