chapter 66 Flashcards
The nurse is caring for a client who is hospitalized for initiation of regional antibiotic
irrigation for acute osteomyelitis of the right femur. Which of the following interventions
should be included in the plan of care?
a. Immobilization of the right leg
b. Frequent weight-bearing exercise
c. Avoiding administration of nonsteroidal anti-inflammatory drugs (NSAIDs)
d. Support of the right leg in a flexed position
A
Immobilization of the affected leg helps decrease pain and reduce the risk for pathological
fractures. Weight-bearing exercise increases the risk for pathological fractures. NSAIDs
are frequently prescribed to treat pain. Flexion of the affected limb is avoided to prevent
contractures.
The nurse is preparing a client for discharge after 2 weeks of IV antibiotic therapy for
acute osteomyelitis in the left leg. Which of the following information should be included
in the discharge teaching?
a. How to apply warm packs safely to the leg to reduce pain?
b. How to monitor and care for the long-term IV catheter site?
c. The need for daily aerobic exercise to help maintain muscle strength
d. The reason for taking oral antibiotics for 7–10 days after discharge
B
The client will be on IV antibiotics for several months, and the client will need to
recognize signs of infection at the IV site and how to care for the catheter during daily
activities such as bathing. IV antibiotics rather than oral antibiotics are used for acute
osteomyelitis. Clients are instructed to avoid exercise and heat application because these
will increase swelling and the risk for spreading infection.
The home care nurse is caring for a client who has chronic osteomyelitis of the left femur
who is being managed at home with administration of IV antibiotics. Which of the
following findings would indicate to the nurse that a nursing diagnosis of ineffective
health maintenance is appropriate for this client?
a. Takes and records the oral temperature twice a day
b. Is unable to plantar flex the foot on the affected side
c. Uses crutches to avoid weight bearing on the affected leg
d. Is irritable and frustrated with the length of treatment required
B
Foot drop is an indication that the foot is not being supported in a neutral position by a
splint. Using crutches and monitoring the oral temperature are appropriate self-care
activities. Frustration with the length of treatment is not an indicator of ineffective health
maintenance of the osteomyelitis.
Which of the following statements by a client who is scheduled for an above-the-knee
amputation for treatment of an osteosarcoma of the right tibia indicates that client teaching
is needed?
a. “I did not have this bone cancer until my leg broke a week ago.”
b. “I wish that I did not have to have chemotherapy after this surgery.”
c. “I know that I will need to participate in physical therapy after surgery.”
d. “I will use the patient-controlled analgesia (PCA) to control postoperative pain.”
A
Ewing’s sarcoma may be diagnosed following a fracture, but it is not caused by the injury.
The other client statements indicate that client teaching has been effective.
The nurse is caring for a client with pes planus. Which of the following actions should the
nurse expect to provide symptom relief for this client?
a. The administration of a corticosteroid
b. The use of longitudinal arch supports
c. Passive manual stretching of the PIP joint
d. Casting of the affected foot
B
Symptoms of pes planus are usually relieved by use of resilient longitudinal arch supports.
Casting of the affected foot, passive manual stretching of the PIP joint, and the
administration of a corticosteroid are not part of the treatment for pes planus.
The nurse is caring for a client who has muscle spasms and acute low back pain. Which of
the following actions is most appropriate to teach the client to promote comfort?
a. Avoid the use of cold because it will exacerbate the muscle spasms.
b. Keep both feet flat on the floor when prolonged standing is required.
c. Keep the hips and knees flexed when resting in bed.
d. Twist gently from side to side to maintain range of motion in the spine.
C
Resting with the hips and knees flexed will reduce the strain on the back and decrease
muscle spasms. Twisting from side to side will increase tension on the lumbar area. A
pillow placed under the upper back will cause strain on the lumbar spine. Alternate
application of cold and heat should be used to decrease pain.
The nurse is teaching a client whose work involves lifting and has a history of chronic
back pain about proper body mechanics. Which of the following client statements
indicates that the teaching has been effective?
a. “I plan to start doing exercises to strengthen the muscles of my back.”
b. “I will try to sleep with my hips and knees extended to prevent back strain.”
c. “I can tell my boss that I need to change to a job where I can work at a desk.”
d. “I will keep my back straight when I need to lift anything higher than my waist.”
A
Exercises can help to strengthen the muscles that support the back. Flexion of the hips and
knees places less strain on the back. Modifications in the way the client lifts boxes are
needed, but sitting for prolonged periods can aggravate back pain. The client should not
lift above the level of the elbows.
The nurse is caring for a client who has a herniated intravertebral disk who has had a
laminectomy and discectomy. Following the surgery, which of the following actions
should the nurse implement to position the client on his or her side?
a. Instruct the client to move the legs before turning the rest of the body.
b. Have the client turn by grasping the side rails and pulling the shoulders over.
c. Place a pillow between the client’s legs and turn the entire body as a unit.
d. Turn the client’s head and shoulders first, followed by the hips, legs, and feet.
C
The spine should be kept in correct alignment after laminectomy. The other positions will
create misalignment of the spine.
The nurse is teaching a client with a bunion about how to prevent further problems. Which
of the following client statements indicates that more teaching is required?
a. “I will throw away my high heel shoes.”
b. “I will use the bunion pad to relieve the pain.”
c. “I will need to wear open sandals at all times.”
d. “I will take ibuprofen when I need it.”
C
The client can wear shoes that have a wide forefoot. The other client statements indicate
that the teaching has been effective.
Which of the following assessment findings should alert the nurse to the presence of
osteoporosis in an adult client?
a. Measurable loss of height
b. Presence of bowed legs
c. Aversion to dairy products
d. Statements about frequent falls
A
Osteoporosis occurring in the vertebrae produces a gradual loss of height. Bowed legs are
associated with osteomalacia. Low intake of dairy products is a risk factor for osteoporosis,
but it does not indicate that osteoporosis is present. Frequent falls increase the risk for
fractures but are not an indicator of osteoporosis.
The nurse is caring for an older female adult client who has a family history of
osteoporosis and is diagnosed with osteopenia following densitometry testing. Which of
the following explanations should the nurse provide when teaching the client about
osteoporosis?
a. Estrogen replacement therapy must be started to prevent rapid progression to
osteoporosis.
b. Continuous, low-dose corticosteroid treatment is effective in stopping the course of
osteoporosis.
c. With a family history of osteoporosis, there is no way to prevent or slow gradual
bone resorption.
d. Calcium loss from bones can be slowed by increasing calcium intake and
weight-bearing exercise.
D
Progression of osteoporosis can be slowed by increasing calcium intake and
weight-bearing exercise. Estrogen replacement therapy does help prevent osteoporosis, but
it is not the only treatment and is not appropriate for some clients. Corticosteroid therapy
increases the risk for osteoporosis.
Which of the following menu choices by a client with osteoporosis indicates that the
nurse’s teaching about appropriate diet has been effective?
a. Pancakes with syrup and bacon
b. Whole wheat toast and fruit jelly
c. Two-egg omelette and a half grapefruit
d. Oatmeal with skim milk and fruit yogourt
D
Skim milk and yogourt are high in calcium. The other choices do not contain any high
calcium foods.
The nurse is caring for a client who has Paget’s disease and is prescribed salmon
calcitonin and acetaminophen. Which of the following assessment information will the
nurse obtain to evaluate the effectiveness of these medications?
a. Pain level
b. Oral intake
c. Daily weight
d. Grip strength
A
Bone pain is one of the common early manifestations of Paget’s disease, and the nurse
should assess the pain level to determine whether the treatment is effective. The other
information will also be collected by the nurse, but will not be used in evaluating the
effectiveness of the therapy.
The nurse is caring for a client who has acute osteomyelitis and is receiving tobramycin 80
mg IV twice daily. Which of the following actions should the nurse take before
administering the gentamicin?
a. Ask the client about any nausea.
b. Obtain the client’s oral temperature.
c. Change the prescribed wet-to-dry dressing.
d. Review the client’s blood urea nitrogen (BUN) and creatinine levels.
D
Gentamicin is nephrotoxic and can cause renal failure. Monitoring the client’s temperature
before gentamicin administration is not necessary. Nausea is not a common adverse effect
of IV gentamicin. There is no need to change the dressing before gentamicin
administration.
The nurse is caring for a client who has had a surgical reduction of an open fracture of the
left tibia. Which of the following assessment findings is most important to report to the
health care provider?
a. Left leg muscle spasms
b. Serous wound drainage
c. Left leg pain with movement
d. Temperature 38.6°C (101.5°F)
D
An elevated temperature is suggestive of possible osteomyelitis. The other clinical
manifestations are typical after a repair of an open fracture.
