Nokea
A nurse is caring for a patient who is being treated in the hospital for a spontaneous vertebral fracture related to osteoporosis. The nurse should address the nursing diagnosis of Acute Pain Related to Fracture by implementing what intervention?
- A. Maintenance of high Fowler's positioning whenever possible
- B. Intermittent application of heat to the patient's back
- C. Use of a pressure-reducing mattress
- D. Passive range of motion exercises
Correct Answer: B
Rationale: Intermittent local heat and back rubs promote muscle relaxation following osteoporotic vertebral fractures. High Fowler's positioning is likely to exacerbate pain. The mattress must be adequately supportive, but pressure reduction is not necessarily required. Passive range of motion exercises to the back would cause pain and impair healing.
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An older adult patient sought care for the treatment of a swollen, painful knee joint. Diagnostic imaging and culturing of synovial fluid resulted in a diagnosis of septic arthritis. The nurse should prioritize which of the following aspects of care?
- A. Administration of oral and IV corticosteroids as ordered
- B. Prevention of falls and pathologic fractures
- C. Maintenance of adequate serum levels of vitamin D
- D. Intravenous administration of antibiotics
Correct Answer: D
Rationale: IV antibiotics are the major treatment modality for septic arthritis; the nurse must ensure timely administration of these drugs. Corticosteroids are not used to treat septic arthritis and vitamin D levels are not necessarily affected. Falls prevention is important, but septic arthritis does not constitute the same fracture risk as diseases with decreased bone density.
An orthopedic nurse is caring for a patient who is postoperative day one following foot surgery. What nursing intervention should be included in the patient's subsequent care?
- A. Dressing changes should not be performed unless there are clear signs of infection.
- B. The surgical site can be soaked in warm bath water for up to 5 minutes.
- C. The surgical site should be cleansed with hydrogen peroxide once daily.
- D. The foot should be elevated in order to prevent edema.
Correct Answer: D
Rationale: Pain experienced by patients who undergo foot surgery is related to inflammation and edema. To control the anticipated edema, the foot should be elevated on several pillows when the patient is sitting or lying. Regular dressing changes are performed and the wound should be kept dry. Hydrogen peroxide is not used to cleanse surgical wounds.
A patient presents at a clinic complaining of pain in his heel so bad that it inhibits his ability to walk. The patient is subsequently diagnosed with plantar fasciitis. This patient's plan of care should include what intervention?
- A. Wrapping the affected area in lambs wool or gauze to relieve pressure
- B. Gently stretching the foot and the Achilles tendon
- C. Wearing open-toed shoes at all times
- D. Applying topical analgesic ointment to plantar surface each morning
Correct Answer: B
Rationale: Plantar fasciitis leads to pain that is localized to the anterior medial aspect of the heel and diminishes with gentle stretching of the foot and Achilles tendon. Dressings of any kind are not of therapeutic benefit and analgesic ointments do not address the pathology of the problem. Open-toed shoes are of no particular benefit.
A nurse is providing a class on osteoporosis at the local seniors center. Which of the following statements related to osteoporosis is most accurate?
- A. Osteoporosis is categorized as a disease of the elderly.
- B. A nonmodifiable risk factor for osteoporosis is a person's level of activity.
- C. Secondary osteoporosis occurs in women after menopause.
- D. Slow discontinuation of corticosteroid therapy can halt the progression of the osteoporosis.
Correct Answer: D
Rationale: When corticosteroid therapy is discontinued, the progression of osteoporosis is halted, but restoration of lost bone mass does not occur. Osteoporosis is not a disease of the elderly because its onset occurs earlier in life, when bone mass peaks and then begins to decline. A person's level of physical activity is a modifiable factor that influences peak bone mass. Lack of activity increases the risk for the development of osteoporosis. Primary osteoporosis occurs in women after menopause.
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.