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Which of the following patients should the nurse recognize as being at the highest risk for the development of osteomyelitis?
- A. A middle-age adult who takes ibuprofen daily for rheumatoid arthritis
- B. An elderly patient with an infected pressure ulcer in the sacral area
- C. A 17-year-old football player who had orthopedic surgery 6 weeks prior
- D. An infant diagnosed with jaundice
Correct Answer: B
Rationale: Patients who are at high risk of osteomyelitis include those who are poorly nourished, elderly, and obese. The elderly patient with an infected sacral pressure ulcer is at the greatest risk for the development of osteomyelitis, as this patient has two risk factors: age and the presence of a soft-tissue infection that has the potential to extend into the bone. The patient with rheumatoid arthritis has one risk factor and the infant with jaundice has no identifiable risk factors. The patient 6 weeks postsurgery is beyond the usual window of time for the development of a postoperative surgical wound infection.
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A nurse is providing a class on osteoporosis at the local seniors center. Which of the following statements related to osteoporosis is most accurate?
- A. Osteoporosis is categorized as a disease of the elderly.
- B. A nonmodifiable risk factor for osteoporosis is a person's level of activity.
- C. Secondary osteoporosis occurs in women after menopause.
- D. Slow discontinuation of corticosteroid therapy can halt the progression of the osteoporosis.
Correct Answer: D
Rationale: When corticosteroid therapy is discontinued, the progression of osteoporosis is halted, but restoration of lost bone mass does not occur. Osteoporosis is not a disease of the elderly because its onset occurs earlier in life, when bone mass peaks and then begins to decline. A person's level of physical activity is a modifiable factor that influences peak bone mass. Lack of activity increases the risk for the development of osteoporosis. Primary osteoporosis occurs in women after menopause.
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.
A nurse is reviewing the pathophysiology that may underlie a patient's decreased bone density. What hormone should the nurse identify as inhibiting bone resorption and promoting bone formation?
- A. Estrogen
- B. Parathyroid hormone (PTH)
- C. Calcitonin
- D. Progesterone
Correct Answer: C
Rationale: Calcitonin inhibits bone resorption and promotes bone formation, estrogen inhibits bone breakdown, and parathyroid increases bone resorption. Estrogen, which inhibits bone breakdown, decreases with aging. Parathyroid hormone (PTH) increases with aging, increasing bone turnover and resorption. Progesterone is the major naturally occurring human progestogen and plays a role in the female menstrual cycle.
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 caring for a patient who is being assessed following complaints of severe and persistent low back pain. The patient is scheduled for diagnostic testing in the morning. Which of the following are appropriate diagnostic tests for assessing low back pain?
- A. Computed tomography (CT)
- B. Angiography
- C. Magnetic resonance imaging (MRI)
- D. Ultrasound
- E. X-ray
Correct Answer: A,C,D,E
Rationale: A variety of diagnostic tests can be used to address lower back pain, including CT, MRI, ultrasound, and X-rays. Angiography is not related to the etiology of back pain.