Nokea
A patient is undergoing diagnostic testing for osteomalacia. Which of the following laboratory results is most suggestive of this diagnosis?
- A. High chloride, calcium, and magnesium
- B. High parathyroid and calcitonin levels
- C. Low serum calcium and magnesium levels
- D. Low serum calcium and low phosphorus level
Correct Answer: D
Rationale: Laboratory studies will reveal a low serum calcium and low phosphorus level.
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A patient has returned to the unit after undergoing limb-sparing surgery to remove a metastatic bone tumor. The nurse providing postoperative care in the days following surgery assesses for what complication from surgery?
- A. Deficient fluid volume
- B. Delayed wound healing
- C. Hypocalcemia
- D. Pathologic fractures
Correct Answer: B
Rationale: Delayed wound healing is a complication of surgery due to tissue trauma from the surgery. Nutritional deficiency is usually due to the effects of chemotherapy and radiation therapy, which may cause weight loss. Pathologic fractures are not a complication of surgery.
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 nurse is assessing a patient who reports a throbbing, burning sensation in the right foot. The patient states that the pain is worst during the day but notes that the pain is relieved with rest. The nurse should recognize the signs and symptoms of what health problem?
- A. Morton's neuroma
- B. Pescavus
- C. Hallux valgus
- D. Onychocryptosis
Correct Answer: A
Rationale: Morton's neuroma is a swelling of the third (lateral) branch of the median plantar nerve, which causes a throbbing, burning pain, usually relieved with rest. Pescavus refers to a foot with an abnormally high arch and a fixed equinus deformity of the forefoot. Hallux valgus (bunion) is 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. Onychocryptosis (ingrown toenail) occurs when the free edge of a nail plate penetrates the surrounding skin, laterally or anteriorly.
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 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.