Nokea
The nurse has received a prescription for an oral bisphosphonate for a client with osteoporosis. Which finding in the client's medical history would contraindicate the administration of this medication?
- A. diabetes mellitus
- B. hypercalcemia
- C. lactose intolerance
- D. Roux-en-Y gastric bypass
Correct Answer: D
Rationale: Roux-en-Y gastric bypass alters gastrointestinal absorption, reducing the efficacy of oral bisphosphonates and increasing the risk of esophageal or gastric irritation. Diabetes mellitus, hypercalcemia, and lactose intolerance are not absolute contraindications, though hypercalcemia requires monitoring.
You may also like to solve these questions
The following scenario applies to the next 1 items
The nurse in the emergency department (ED) is caring for a 62-year-old female client.
Item 1 of 1
Triage Note
1211: The client was brought to the ED by her neighbor, who was concerned about her increasing pain and immobility. The client's neighbor reported that the client called her a few hours ago, asking her to go to the ED because of increasing pain and the inability to perform her activities of daily living. History of osteoporosis, hypertension, and gout. She reports that she recently started seeing a rheumatologist because of persistent fatigue, low-grade fevers, and lack of appetite. Vital signs: T 99.7° F (37.6° C), P 82, RR 16, BP 134/76, pulse oximetry reading 98% on room air. Pain rated 7/10 on the Numerical Rating Scale, which is described as throbbing of both feet, especially in her toes. She also reports having stiffness in her wrists and fingers that starts in the morning and persists throughout the day. Triage assessment: the client is alert and fully oriented to person, place, and situation. Peripheral pulses 2+. Clear lung sounds bilaterally. Swollen, errythemic toes that are warm and tender to touch. She does not recall her weight but reports significant weight loss over the past three months.
For each assessment finding below, click to specify if the finding is consistent with the disease process of osteoarthritis, acute gout flare, or rheumatoid arthritis. Each finding may support more than 1 disease process.
- A. Low-grade fever
- B. Weight loss
- C. Redness and warmth of the affected joint
- D. Morning joint stiffness in the wrists that lasts throughout the day
- E. Pain with movement in the affected joint
- F. Reduced range of motion in the affected joint
- G. Pain level
Correct Answer: A: Rheumatoid Arthritis, Acute Gout Flare, B: Rheumatoid Arthritis, C: Rheumatoid Arthritis, Acute Gout Flare, D: Rheumatoid Arthritis, E: Osteoarthritis, Rheumatoid Arthritis, Acute Gout Flare, F: Osteoarthritis, Rheumatoid Arthritis, Acute Gout Flare, G: Osteoarthritis, Rheumatoid Arthritis, Acute Gout Flare
Rationale: Seen in inflammatory conditions; not typical in osteoarthritis. Chronic systemic inflammation may lead to unintentional weight loss. Indicates joint inflammation; osteoarthritis does not usually present with warmth or redness. Stiffness >1 hour, especially in small joints, is classic for RA. Movement worsens pain in all these conditions, though the cause differs. All limit ROM due to stiffness, inflammation, or damage. Pain is a shared feature, though severity and timing vary.
The nurse in the medical-surgical unit is caring for a newly admitted client.
Item 5 of 6
History and Physical
1930: Client is a 45-year-old male who has a one-and-a-half-week history of pain, redness, and swelling in his right foot. He reported that the symptoms began after he accidentally cut his foot while walking barefoot in his backyard. Over the next few days, he developed pain and swelling around the cut, accompanied by redness and warmth. He went to urgent care two days later and was diagnosed with cellulitis in his right foot. He was prescribed antibiotics but could not afford the treatment. Three days ago, the pain escalated and was described as throbbing and constant, with a severity rating of 7/10 on the Numerical Pain Rating Scale. He states, "the pain is now in the bone of my foot; I don't know how else to describe it." He also noted occasional fever 101°F (38.3°C), chills, and general malaise. On physical examination, his right foot was erythematous, swollen, and warm to the touch. A 3 cm ulcer was noted on the plantar aspect of the right foot, with moderate purulent discharge present. The ulcer appeared deep, and palpation of the surrounding tissue elicited tenderness. There was limited range of motion in the right ankle due to pain. The distal pulses were palpable 2+, and there were signs of neuropathy in the feet (decreased sensation to light touch and pinprick). He has a medical history of uncontrolled diabetes mellitus (type two), obesity, peripheral neuropathy in all extremities, hypertension, hyperlipidemia, and epilepsy.
Orders
2100:
Magnetic resonance imaging of the right foot without contrast
Insert peripheral vascular access device
Laboratory tests: blood culture and sensitivity (C & S), complete blood count (CBC), complete metabolic panel (CMP), lactic acid
vancomycin 1 g, IV, every 12 hours
Wound culture
fentanyl 50 mcg IV, every 5 hours PRN pain
Consultation
Infectious Disease Consultation
2050: Client was evaluated and I strongly suspect osteomyelitis in his right foot. Labs are pending. Agree with admission and will follow closely.
Nurses' Notes
2110: Orders received and reviewed. Vital signs: T 103° F (39.4° C), P 92, RR 18, BP 141/87, pulse oximetry reading 98% on room air. Client reports pain '8' on the Numerical Pain Scale.
The nurse reviews the physician's orders, client's laboratory data, and makes an entry into the nurses' notes. Which of the following actions should the nurse take?
- A. Withhold administering the prescribed antibiotic and notify the physician.
- B. Place a dressing over the client's wound before transporting the client to MRI.
- C. Notify the physician to hold the ordered MRI because of the client's kidney function.
- D. Instruct the client to remove all metal objects before the MRI.
- E. Administer prescribed pain medication before the MRI.
- F. Irrigate the wound with 0.9% sodium chloride (normal saline) before obtaining wound culture.
- G. Request a prescription for a nonsteroidal anti-inflammatory drug.
Correct Answer: B, D, E, F
Rationale: B: A dressing protects the wound during transport. D: Removing metal prevents MRI interference. E: Pain medication improves comfort for MRI. F: Irrigation ensures a clean sample for culture. A and C require more data, and G is not urgent.
While caring for a patient who has recently suffered from a fracture, the nurse sees that the patient's injured extremity will be placed in traction. Which of the following actions should the nurse refrain from performing?
- A. Keeping the pulley system tightened so that they may not move freely
- B. Check the ropes for fraying or breaks
- C. Keep the weights above the floor
- D. Ensure proper body alignment
Correct Answer: A
Rationale: Tightening the pulley system to prevent free movement can disrupt traction's purpose of maintaining alignment and pull. Checking ropes, keeping weights off the floor, and ensuring alignment are all appropriate.
The nurse is caring for a client who is in Buck traction. Which of the following actions should the nurse take?
- A. Ensure that weight is between 15 to 30 lb (6.8 to 13.6 kg)
- B. Turn the client using a foam wedge every two hours
- C. Ensure that a client's heels are supported with a pillow
- D. Elevate the foot of the bed to provide counter traction
Correct Answer: D
Rationale: Elevating the foot of the bed provides counter traction to maintain alignment in Buck traction. Excessive weight risks injury, turning disrupts traction, and heel support is good but not the priority.
The nurse in the medical-surgical unit is caring for a newly admitted client.
Item 2 of 6
History and Physical
1930: Client is a 45-year-old male who has a one-and-a-half-week history of pain, redness, and swelling in his right foot. He reported that the symptoms began after he accidentally cut his foot while walking barefoot in his backyard. Over the next few days, he developed pain and swelling around the cut, accompanied by redness and warmth. He went to urgent care two days later and was diagnosed with cellulitis in his right foot. He was prescribed antibiotics but could not afford the treatment. Three days ago, the pain escalated and was described as throbbing and constant, with a severity rating of 7/10 on the Numerical Pain Rating Scale. He states, "the pain is now in the bone of my foot; I don't know how else to describe it." He also noted occasional fever 101°F (38.3°C), chills, and general malaise. On physical examination, his right foot was erythematous, swollen, and warm to the touch. A 3 cm ulcer was noted on the plantar aspect of the right foot, with moderate purulent discharge present. The ulcer appeared deep, and palpation of the surrounding tissue elicited tenderness. There was limited range of motion in the right ankle due to pain. The distal pulses were palpable 2+, and there were signs of neuropathy in the feet (decreased sensation to light touch and pinprick). He has a medical history of uncontrolled diabetes mellitus (type two), obesity, peripheral neuropathy in all extremities, hypertension, hyperlipidemia, and epilepsy.
Which three (3) findings in the history and physical suggest that the client's condition is worsening?
- A. Chills
- B. Sensation in feet
- C. Fever
- D. Erythema
- E. General malaise
Correct Answer: A, C, E
Rationale: Chills, fever, and general malaise indicate systemic infection or worsening, possibly osteomyelitis, especially with a history of untreated cellulitis. Sensation loss is chronic, and erythema is an earlier sign not necessarily worsening.