LEWIS- CH 63 Flashcards
A patient with acute osteomyelitis of the left femur is hospitalized for regional antibiotic irrigation. Which intervention should the nurse include in the initial plan of care?
a. Quadriceps-setting exercises
b. Immobilization of the left leg
c. Positioning the left leg in flexion
d. Assisted weight-bearing ambulation
ANS: B Immobilization of the affected leg helps to decrease pain and reduce the risk for pathologic fracture. Weight-bearing exercise increases the risk for pathologic fractures. Flexion of the affected limb is avoided to prevent contractures.
A patient is being discharged after 1 week of IV antibiotic therapy for acute osteomyelitis in the right leg. Which information should the nurse include in the discharge teaching?
a. How to apply warm packs to the leg to reduce pain
b. How to monitor and care for a long-term IV catheter
c. The need for daily aerobic exercise to help maintain muscle strength
d. The reason for taking oral antibiotics for 7 to 10 days after discharge
ANS: B The patient will be taking IV antibiotics for several months. The patient will need to recognize signs of infection at the IV site and know how to care for the catheter during daily activities such as bathing. IV antibiotics rather than oral antibiotics are used for acute osteomyelitis. Patients are instructed to avoid exercise and heat application because these will increase swelling and the risk for spreading infection.
A patient is receiving IV antibiotics at home to treat chronic osteomyelitis of the left femur. Which statement by the patient should indicate to the nurse the need for additional teaching related to health maintenance?
a. “I’m frustrated with this endless treatment!”
b. “I will take my oral temperature twice a day.”
c. “I think my left foot is starting to droop down.”
d. “I use crutches to avoid weight bearing on the left leg.”
ANS: C Footdrop 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.
The nurse instructs a patient who has osteosarcoma of the tibia about a scheduled above-the-knee amputation. Which patient statement indicates to the nurse that additional teaching is needed?
a. “I will need to participate in physical therapy after surgery.”
b. “I wish I did not need to have chemotherapy after this surgery.”
c. “I did not have this bone cancer until my leg broke a week ago.”
d. “I can use the patient-controlled analgesia (PCA) to manage postoperative pain.”
ANS: C Osteogenic sarcoma may be diagnosed following a fracture, but it is not caused by the injury. The other statements indicate patient teaching has been effective.
A patient with muscular dystrophy is hospitalized with pneumonia. Which nursing action should the nurse include in the plan of care?
a. Logroll the patient every 2 hours.
b. Assist the patient with ambulation.
c. Discuss the need for genetic testing with the patient.
d. Teach the patient about the muscle biopsy procedure.
ANS: B Because the goal for the patient with muscular dystrophy is to keep the patient active for as long as possible, assisting the patient to ambulate will be part of the care plan.
What should the nurse include in the teaching plan for ae patient who has acute low back pain and muscle spasms?
a. Keep both feet flat on the floor when prolonged standing is required.
b. Twist gently from side to side to maintain range of motion in the spine.
c. Keep the head elevated slightly and flex the knees when resting in bed.
d. Avoid the use of cold packs because they will exacerbate the muscle spasms.
ANS: C Resting with the head elevated 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. Prolonged standing will cause strain on the lumbar spine, even with both feet flat on the floor. Alternate application of cold and heat should be used to decrease pain.
A patient whose employment requires frequent lifting has a history of chronic back pain. After the nurse has taught the patient about correct body mechanics, which patient statement indicates the teaching has been effective?
a. “I will keep my back straight when I lift above than my waist.”
b. “I will begin doing exercises to strengthen and support my back.”
c. “I will tell my boss I need a job where I can stay seated at a desk.”
d. “I can sleep with my hips and knees extended to prevent back strain.”
ANS: B Exercises can help strengthen the muscles that support the back. Flexion of the hips and knees places less strain on the back than keeping these joints extended. Sitting for prolonged periods can aggravate back pain. Modification in the way the patient lifts boxes is needed, but the patient should not lift above the level of the elbows.
Which action should the nurse take when repositioning the patient who has just had a laminectomy and discectomy?
a. Instruct the patient to move the legs before turning the rest of the body.
b. Place a pillow between the patient’s legs and turn the entire body as a unit.
c. Have the patient turn by grasping the side rails and pulling the shoulders over.
d. Turn the patient’s head and shoulders first, followed by the hips, legs, and feet.
ANS: B The spine should be kept in correct alignment after laminectomy. The other positions will create misalignment of the spine.
Which statement by a patient with discomfort from a bunion indicates to the nurse that more teaching is needed?
a. “I will give away my high-heeled shoes.”
b. “I can take ibuprofen (Motrin) if I need it.”
c. “I will use the bunion pad to cushion the area.”
d. “I can only wear sandals, no closed-toe shoes.”
ANS: D The patient can wear shoes that have a wide forefoot (toe box). The other patient statements indicate the teaching has been effective.
Which assessment finding for a 55-yr-old patient should alert the nurse to the presence of osteoporosis?
a. Bowed legs
b. Loss of height
c. Report of frequent falls
d. Aversion to dairy products
ANS: B Osteoporosis occurring in the vertebrae produces a gradual loss of height. Bowed legs are associated with osteomalacia and osteoarthritis. Low intake of dairy products is a risk factor for osteoporosis, but it does not indicate osteoporosis is present. Frequent falls increase the risk for fractures but are not an indicator of osteoporosis.
A 54-yr-old woman who recently reached menopause and has a family history of osteoporosis is diagnosed with osteopenia. Which information should the nurse explain to the patient?
a. With a family history of osteoporosis, there is no way to prevent or slow bone resorption.
b. Estrogen replacement therapy must be started to prevent rapid progression to osteoporosis. c. Continuous, low-dose corticosteroid treatment is effective in stopping the course of osteoporosis.
d. Calcium loss from bones can be slowed by increasing calcium intake and weight-bearing exercise.
ANS: D Progression of osteoporosis can be slowed by increasing calcium intake and weight-bearing exercise. Estrogen replacement therapy is no longer routinely given to prevent osteoporosis because of increased risk of heart disease as well as breast and uterine cancer. Corticosteroid therapy increases the risk for osteoporosis.
Which menu choice by a patient with osteoporosis indicates the nurse’s teaching about appropriate diet has been effective?
a. Pancakes with syrup and bacon
b. Whole wheat toast and fresh fruit
c. Egg-white omelet and a half grapefruit
d. Oatmeal with skim milk and fruit yogurt
ANS: D Skim milk and yogurt are high in calcium. The other choices do not contain any high-calcium foods.
Which action should the nurse take before administering gentamicin (Garamycin) to a patient with acute osteomyelitis?
a. Ask the patient about any nausea.
b. Obtain the patient’s oral temperature.
c. Change the prescribed wet-to-dry dressings.
d. Review the patient’s serum creatinine results.
ANS: D Gentamicin is nephrotoxic and can cause renal failure as reflected in the patient’s serum creatinine. Monitoring the patient’s temperature before gentamicin administration is not necessary. Nausea is not a common side effect of IV gentamicin. There is no need to change the dressing before gentamicin administration.
A patient has had surgical reduction of an open fracture of the right radius. Which assessment findings should the nurse report immediately to the health care provider?
a. Serous wound drainage
b. Right arm muscle spasms
c. Pain with right arm movement
d. Temperature 101.4° F (38.6° C)
ANS: D An elevated temperature suggests possible osteomyelitis. The other clinical manifestations are typical after a repair of an open fracture.
After laminectomy with a spinal fusion to treat a herniated disc, a patient reports numbness and tingling of the right lower leg. What action should the nurse take?
a. Elevate the right leg on two pillows.
b. Obtain vital signs for indication of hemorrhage.
c. Review the preoperative assessment data in the health record.
d. Turn the patient to the left to relieve pressure on the right leg.
ANS: C The postoperative movement and sensation of the extremities should be unchanged (or improved) from the preoperative assessment. If the numbness and tingling are new, this information should be immediately reported to the surgeon. Numbness and tingling are not symptoms associated with hemorrhage at the site. Turning the patient or elevating the leg will not relieve the numbness.
