Nokea
A patient has come to the clinic for a routine annual physical. The nurse practitioner notes a palpable, painless projection of bone at the patient's shoulder. The projection appears to be at the distal end of the humerus. The nurse should suspect the presence of which of the following?
- A. Osteomyelitis
- B. Osteochondroma
- C. Osteomalacia
- D. Paget's disease
Correct Answer: B
Rationale: Osteochondroma is the most common benign bone tumor. It usually occurs as a large projection of bone at the end of long bones (at the knee or shoulder). Osteomyelitis, osteomalacia, and Paget's disease do not involve the development of excess bone tissue.
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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.
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 nurse is providing care for a patient who has a recent diagnosis of Paget's disease. When planning this patient's nursing care, interventions should address what nursing diagnoses?
- A. Impaired Physical Mobility
- B. Acute Pain
- C. Disturbed Auditory Sensory Perception
- D. Risk for Injury
- E. Risk for Unstable Blood Glucose
Correct Answer: A,B,C,D
Rationale: Patients with Paget's disease are at risk of decreased mobility, pain, hearing loss, and injuries resulting from decreased bone density. Paget's disease does not affect blood glucose levels.
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 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.