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A patient tells the nurse that he has pain and numbness to his thumb, first finger, and second finger of the right hand. The nurse discovers that the patient is employed as an auto mechanic, and that the pain is increased while working. This may indicate that the patient could possibly have what health problem?
- A. Carpel tunnel syndrome
- B. Tendonitis
- C. Impingement syndrome
- D. Dupuytren's contracture
Correct Answer: A
Rationale: Carpel tunnel syndrome may be manifested by numbness, pain, paresthesia, and weakness along the median nerve. Tendonitis is inflammation of muscle tendons. Impingement syndrome is a general term that describes all lesions that involve the rotator cuff of the shoulder. Dupuytren's contracture is a slowly progressive contracture of the palmar fascia.
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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.
An elderly female with osteoporosis has been hospitalized. Prior to discharge, when teaching the patient, the nurse should include information about which major complication of osteoporosis?
- A. Bone fracture
- B. Loss of estrogen
- C. Negative calcium balance
- D. Dowager's hump
Correct Answer: A
Rationale: Bone fracture is a major complication of osteoporosis that results when loss of calcium and phosphate increases the fragility of bones. Estrogen deficiencies result from menopause, not osteoporosis. Calcium and vitamin D supplements may be used to support normal bone metabolism, but a negative calcium balance is not a complication of osteoporosis. Dowager's hump results from bone fractures. It develops when repeated vertebral fractures increase spinal curvature.
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.
A nurse is collaborating with the physical therapist to plan the care of a patient with osteomyelitis. What principle should guide the management of activity and mobility in this patient?
- A. Stress on the weakened bone must be avoided.
- B. Increased heart rate enhances perfusion and bone healing.
- C. Bed rest results in improved outcomes in patients with osteomyelitis.
- D. Maintenance of baseline ADLs is the primary goal during osteomyelitis treatment.
Correct Answer: A
Rationale: The patient with osteomyelitis has bone that is weakened by the infective process and must be protected by avoidance of stress on the bone. This risk guides the choice of activity in a patient with osteomyelitis. Bed rest is not normally indicated, however. Maintenance of prediagnosis ADLs may be an unrealistic short-term goal for many patients.
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.