Nokea
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.
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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 teaching a patient with osteomalacia about the role of diet. What would be the best choice for breakfast for a patient with osteomalacia?
- A. Cereal with milk, a scrambled egg, and grapefruit
- B. Poached eggs with sausage and toast
- C. Waffles with fresh strawberries and powdered sugar
- D. A bagel topped with butter and jam with a side dish of grapes
Correct Answer: A
Rationale: The best meal option is the one that contains the highest dietary sources of calcium and vitamin D. The best selection among those listed is cereal with milk, and eggs, as these foods contain calcium and vitamin D in a higher quantity over the other menu options.
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 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 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.