Nokea
A nurse is providing care for a patient who has osteomalacia. What major goal will guide the choice of medical and nursing interventions?
- A. Maintenance of skin integrity
- B. Prevention of bone metastasis
- C. Maintenance of adequate levels of activated vitamin D
- D. Maintenance of adequate parathyroid hormone function
Correct Answer: C
Rationale: The primary defect in osteomalacia is a deficiency of activated vitamin D, which promotes calcium absorption from the gastrointestinal tract and facilitates mineralization of bone. Interventions are aimed at resolving the processes underlying this deficiency. Maintenance of skin integrity is important, but is not the primary goal in care. Osteomalacia is not a malignant process. Overproduction (not underproduction) of PTH can cause the disease.
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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.
An 80-year-old man in a long-term care facility has a chronic leg ulcer and states that the area has become increasingly painful in recent days. The nurse notes that the site is now swollen and warm to the touch. The patient should undergo diagnostic testing for what health problem?
- A. Osteomyelitis
- B. Osteoporosis
- C. Osteomalacia
- D. Septic arthritis
Correct Answer: A
Rationale: When osteomyelitis develops from the spread of an adjacent infection, no signs of septicemia are present, but the area becomes swollen, warm, painful, and tender to touch. Osteoporosis is the most prevalent bone disease in the world. Osteomalacia is a metabolic bone disease characterized by inadequate mineralization of bone. Septic arthritis occurs when joints become infected through spread of infection from other parts of the body (hematogenous spread) or directly through trauma or surgical instrumentation.
A patient's electronic health record notes that the patient has hallux valgus. What signs and symptoms would the nurse expect this patient to manifest?
- A. Deviation of a great toe laterally
- B. Abnormal flexion of the great toe
- C. An exaggerated arch of the foot
- D. Fusion of the toe joints
Correct Answer: A
Rationale: A deformity in which the great toe deviates laterally and there is a marked prominence of the medial aspect of the first metatarsal-phalangeal joint and exostosis is referred to as hallux valgus (bunion). Hallux valgus does not result in abnormal flexion, abnormalities of the arch, or joint fusion.
A nurse is caring for a patient with a bone tumor. The nurse is providing education to help the patient reduce the risk for pathologic fractures. What should the nurse teach the patient?
- A. Strive to achieve maximum weight-bearing capabilities.
- B. Gradually strengthen the affected muscles through weight training.
- C. Support the affected extremity with external supports such as splints.
- D. Limit reliance on assistive devices in order to build strength.
Correct Answer: C
Rationale: During nursing care, the affected extremities must be supported and handled gently. External supports (splints) may be used for additional protection. Prescribed weight-bearing restrictions must be followed. Assistive devices should be used to strengthen the unaffected extremities.
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.