Nokea
The nurse is caring for a client who sustained a fractured tibia and fibula and has a cast applied to the extremity. Which of the following findings would indicate the client has developed compartment syndrome?
- A. The development of petechiae over the chest
- B. A new onset of dyspnea and chest pain
- C. Severe pain that is unrelieved by an opioid analgesic
- D. Localized bone pain with a fever
Correct Answer: C
Rationale: Severe, unrelieved pain is a hallmark of compartment syndrome, caused by increased pressure within a muscle compartment compromising circulation and nerve function. Petechiae and dyspnea suggest fat embolism, and bone pain with fever may indicate infection.
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The nurse is planning a staff development conference regarding contractures. Which of the following information should the nurse include? Select all that apply.
- A. Range-of-motion exercises of the extremities help prevent contractures.
- B. Splinting the extremities may increase the risk of contractures.
- C. Too many pillows under the head may cause a neck flexion contracture.
- D. Using multiple staff members to reposition a client may prevent a contracture.
- E. Contractures after a hip arthroplasty can be prevented with an abduction pillow.
Correct Answer: A, C, E
Rationale: Range-of-motion exercises maintain joint flexibility and help prevent contractures. Too many pillows under the head can cause the neck to remain flexed, increasing the risk of a flexion contracture. An abduction pillow keeps the legs properly aligned and prevents adduction contractures after hip surgery.
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 is preparing to give alendronate to the client with osteoporosis. The nurse should explain to the client that the expected outcome of this medication is primarily to
- A. decrease bone inflammation
- B. increase synovial fluid in the joint space
- C. inhibit bone resorption
- D. increase serum calcium levels
Correct Answer: C
Rationale: Alendronate, a bisphosphonate, inhibits osteoclast activity, thereby reducing bone resorption and increasing bone density in osteoporosis. It does not primarily reduce inflammation, increase synovial fluid, or directly increase serum calcium levels, which may actually decrease due to reduced bone breakdown.
The nurse in the medical-surgical unit is caring for a newly admitted client.
Item 4 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.
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.
The nurse plans care for this client. For each potential intervention, click to specify whether the intervention is indicated or not indicated for the client.
- A. Warm compress to the client's right foot
- B. Serum complete blood count (CBC)
- C. Serum blood cultures
- D. Administration of prescribed pain medication
- E. Magnetic Resonance Imaging (MRI)
- F. Intravenous fluids: Dextrose 5% in water (D5W)
Correct Answer: A: Not Indicated, B: Indicated, C: Indicated, D: Indicated, E: Indicated, F: Indicated
Rationale: A: Warm compresses may worsen inflammation and infection. B: CBC monitors infection and inflammation. C: Blood cultures identify systemic infection. D: Pain medication addresses severe pain. E: MRI confirms osteomyelitis. F: IV fluids support hydration and antibiotic delivery.
The nurse is caring for a client diagnosed with chronic gout. The nurse anticipates a prescription for which medication to lower uric acid levels?
- A. colchicine
- B. allopurinol
- C. naproxen
- D. prednisone
Correct Answer: B
Rationale: Allopurinol inhibits xanthine oxidase, reducing uric acid production and preventing gout flares in chronic gout. Colchicine and naproxen manage acute inflammation, and prednisone reduces inflammation but does not lower uric acid levels long-term.