A nurse is assessing a client who has a puncture wound on his foot. Which of the following findings is a manifestation of acute osteomyelitis?

Bradycardia

Numbness of toes on the affected foot

Localized erythema

Hypothermia

Answer and Explanation

The Correct Answer is C

A. Bradycardia - This is a slow heart rate and is not a typical manifestation of acute osteomyelitis.

B. Numbness of toes on the affected foot - Numbness may be associated with nerve involvement but is not a classic manifestation of acute osteomyelitis.

C. Localized erythema - This is a characteristic sign of acute osteomyelitis. It indicates inflammation and infection in the affected area.

D. Hypothermia - This is a low body temperature, which is not typically associated with acute osteomyelitis.

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Correct Answer is ["B","C","D"]

Explanation

A. Position weights against the foot of the bed: Incorrect. Weights in Buck's traction are typically hung freely over the end of the bed to provide the necessary countertraction. Placing them against the foot of the bed would not serve this purpose.

B. Examine the skin under the traction splint: Correct. It's important to regularly assess the skin underneath the traction splint to ensure there are no signs of pressure ulcers or skin breakdown.

C. Monitor peripheral pulses in the affected extremity: Correct. This is essential to ensure that blood flow to the extremity is not compromised by the traction.

D. Assess the temperature of the affected extremity: Correct. Monitoring the temperature helps in identifying any signs of impaired circulation.

E. Adjust the prescribed weights every shift: This is not something that should be done without specific orders from the healthcare provider. Adjusting the weights should be done based on the specific plan of care and provider's instructions.

A. Place the client in protective isolation. B. Initiate the use of a PCA pump for pain control. C. Keep the head of the bed at a 30° angle. D. Reposition the client by log rolling every-4 hr.

Correct Answer is D

Explanation

A. Protective isolation is not routinely required for clients following scoliosis repair unless there is an underlying infection risk.
B. A PCA pump may be used for pain control, but it is not specific to post-scoliosis repair care.
C. Keeping the head of the bed at 30° is not required; positioning should focus on spinal alignment.
D. Log rolling the client every 4 hours is essential to maintain spinal alignment, prevent complications, and ensure safety following Harrington rod instrumentation.

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A nurse is assessing a client who has a puncture wound on his foot. Which of the following findings is a manifestation of acute osteomyelitis?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is in Buck's traction. Which of the following actions should the nurse take? (Select all that apply.)

Correct Answer is ["B","C","D"]

Explanation

A nursing is planning care for an adolescent who is postoperative following scoliosis repair with Harrington rod instrumentation. Which of the following interventions should the nurse include in the plan of care?

Correct Answer is D

Explanation

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