Nokea
An orthopedic nurse is caring for a patient who is postoperative day one following foot surgery. What nursing intervention should be included in the patient's subsequent care?
- A. Dressing changes should not be performed unless there are clear signs of infection.
- B. The surgical site can be soaked in warm bath water for up to 5 minutes.
- C. The surgical site should be cleansed with hydrogen peroxide once daily.
- D. The foot should be elevated in order to prevent edema.
Correct Answer: D
Rationale: Pain experienced by patients who undergo foot surgery is related to inflammation and edema. To control the anticipated edema, the foot should be elevated on several pillows when the patient is sitting or lying. Regular dressing changes are performed and the wound should be kept dry. Hydrogen peroxide is not used to cleanse surgical wounds.
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A nursing educator is reviewing the risk factors for osteoporosis with a group of recent graduates. What risk factor of the following should the educator describe?
- A. Recurrent infections and prolonged use of NSAIDs
- B. High alcohol intake and low body mass index
- C. Small frame, female gender, and Caucasian ethnicity
- D. Male gender, diabetes, and high protein intake
Correct Answer: C
Rationale: Small-framed, nonobese Caucasian women are at greatest risk for osteoporosis. Diabetes, high protein intake, alcohol use, and infections are not among the most salient risk factors for osteoporosis.
A nurse is reviewing the care of a patient who has a long history of lower back pain that has not responded to conservative treatment measures. The nurse should anticipate the administration of what drug?
- A. Calcitonin
- B. Prednisone
- C. Aspirin
- D. Cyclobenzaprine
Correct Answer: D
Rationale: Short-term prescription muscle relaxants (e.g., cyclobenzaprine [Flexeril]) are effective in relieving acute low back pain. ASA is not normally used for pain control, due to its antiplatelet action and associated risk for bleeding. Calcitonin and corticosteroids are not used in the treatment of lower back pain.
A nurse is caring for a patient with Paget's disease and is reviewing the patient's most recent laboratory values. Which of the following values is most characteristic of Paget's disease?
- A. An elevated level of parathyroid hormone and low calcitonin levels
- B. A low serum alkaline phosphatase level and a low serum calcium level
- C. An elevated serum alkaline phosphatase level and a normal serum calcium level
- D. An elevated calcitonin level and low levels of parathyroid hormone
Correct Answer: C
Rationale: Patients with Paget's disease have normal blood calcium levels. Elevated serum alkaline phosphatase concentration and urinary hydroxyproline excretion reflect the increased osteoblastic activity associated with this condition.
An older adult woman's current medication regimen includes alendronate (Fosamax). What outcome would indicate successful therapy?
- A. Increased bone mass
- B. Resolution of infection
- C. Relief of bone pain
- D. Absence of tumor spread
Correct Answer: A
Rationale: Bisphosphonates such as Fosamax increase bone mass and decrease bone loss by inhibiting osteoclast function. These drugs do not treat infection, pain, or tumors.
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.