Nokea
The nurse reviews the client's clinical data. Which action should the nurse take based on the clinical data?
- A. Administer the prescribed ketorolac
- B. Remove the heating pad from the client's lower back
- C. Contact the physician to question the prescription of ketorolac
- D. Reposition the client to the side of the bed and have them twist from side to side
- E. Remove and discard the prescribed fentanyl patch because of its lack of efficacy
Correct Answer: B
Rationale: Removing the heating pad is appropriate, as heat can worsen inflammation or strain in low back pain. Ketorolac may be suitable, twisting risks harm, and fentanyl efficacy needs more data before removal.
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The nurse is conducting a client teaching session at the clinic for a client who has been prescribed a bisphosphonate for osteoporosis treatment. Which instructions should the nurse provide to this client?
- A. Take this medication sitting upright first thing in the morning with a full glass of water
- B. Take this medication at night, just before bed
- C. This medication should be taken with a full meal
- D. This medication is the best alternative if an esophageal disorder is present
Correct Answer: A
Rationale: Bisphosphonates like alendronate must be taken sitting upright first thing in the morning with a full glass of water to ensure proper absorption and minimize esophageal irritation. Taking it at night, with food, or with an esophageal disorder increases the risk of esophageal damage or reduced efficacy.
The nurse reviews newly prescribed medications from the primary healthcare provider (PHCP). The nurse understands that the prescribed etanercept is intended to treat which condition?
- A. Osteoarthritis
- B. Diabetes mellitus
- C. Infective endocarditis (IE)
- D. Rheumatoid arthritis
Correct Answer: D
Rationale: Etanercept is a tumor necrosis factor (TNF) inhibitor used to treat autoimmune conditions like rheumatoid arthritis by reducing inflammation and joint damage. Osteoarthritis is not autoimmune, diabetes mellitus affects glucose metabolism, and infective endocarditis is a bacterial infection, none of which are treated with etanercept.
The nurse in the medical-surgical unit is caring for a newly admitted client.
Item 3 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 reviews the consultation report from the infectious disease physician. Select the complications that the client is at risk for developing? Select all that apply.
- A. Rheumatoid arthritis
- B. Osteosarcoma
- C. Avascular necrosis
- D. Sepsis
- E. Paget's disease
- F. Hyperosmolar hyperglycemic nonketotic syndrome
Correct Answer: C, D
Rationale: With suspected osteomyelitis and uncontrolled diabetes, the client risks avascular necrosis due to poor blood supply and sepsis from untreated infection spreading. Rheumatoid arthritis and osteosarcoma are unrelated, and Paget's is a chronic bone disorder.
The nurse is caring for a client with a newly applied plaster cast. The nurse should
- A. Use a small object like a pencil or ruler to itch the leg if it becomes uncomfortable.
- B. Expedite drying by using a hot blow dryer on the cast.
- C. Let the cast hang below the heart to promote blood flow.
- D. Handle the cast with the palms of the hands.
Correct Answer: D
Rationale: Handling a wet plaster cast with the palms prevents denting, which could cause pressure points. Scratching inside risks skin damage, hot dryers can burn, and a dependent position increases swelling.
The nurse is developing a plan of care for a patient who has a halo vest immobilizer (halo brace) following a cervical spine fracture. Which of the following should the nurse include in the patient's plan of care?
- A. Pin care every shift
- B. Neck flexion and extension exercises
- C. Taping the wrench to the vest
- D. Report loosening of the pins
- E. Use straws when providing liquids
Correct Answer: A, D, E
Rationale: Pin care prevents infection, reporting loose pins ensures stability, and straws aid safe drinking. Neck exercises are contraindicated as they risk spinal injury, and taping the wrench is standard but not always required unless specified.