A 7-year-old girl is receiving IV antibiotics for osteomyelitis in the left femur.
After 72 hours of treatment, she continues to have fever, elevated WBC, and increased pain at the infection site. What is the nurse's priority action?
Notify the provider of the lack of therapeutic response.
Request an order for oral analgesics to reduce discomfort.
Encourage intake of calcium-rich foods to support bone healing.
Reassure the family that antibiotic therapy can take several days to show improvement.
The Correct Answer is A
Choice A rationale
Persistent fever, elevated white blood cell count (normal range: 4,000-11,000 cells/µL), and increased pain after 72 hours of antibiotic treatment for osteomyelitis indicate a lack of therapeutic response. This suggests the current antibiotic regimen may be ineffective, or the infection is not responding as expected. Prompt notification of the provider is crucial for re-evaluation of the treatment plan, potential antibiotic adjustment, or further diagnostic investigation to prevent complications like sepsis or chronic osteomyelitis.
Choice B rationale
While pain management is important, requesting only oral analgesics addresses a symptom without addressing the underlying lack of improvement in the infection. Untreated or inadequately treated osteomyelitis can lead to significant morbidity. Prioritizing symptomatic relief over addressing the root cause can delay appropriate medical intervention and worsen the patient's condition.
Choice C rationale
While calcium (normal range: 8.5-10.5 mg/dL) is vital for bone health, encouraging calcium-rich foods is a long-term supportive measure for bone healing. It does not address the immediate and concerning signs of ongoing, uncontrolled infection. Addressing the active infection takes precedence over nutritional support for healing at this stage.
Choice D rationale
While antibiotic therapy does take time to show full effect, 72 hours with worsening symptoms, including elevated WBC, suggests the current therapy is failing. Reassuring the family without addressing these objective signs of non-improvement can delay necessary medical intervention and potentially harm the patient by allowing the infection to progress further.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
When bone fragments remain partially joined, this describes an incomplete fracture, such as a greenstick fracture often seen in children, where the bone bends and cracks but does not break completely through. This is distinct from a complete fracture where there is full separation of the bone.
Choice B rationale
A complete fracture is scientifically defined as a break in a bone where the bone fragments are entirely separated from each other. This total discontinuity interrupts the structural integrity of the bone, distinguishing it from partial breaks where some bone continuity is maintained.
Choice C rationale
When the bone penetrates the skin, this describes an open (or compound) fracture. While an open fracture is also a complete fracture, the defining characteristic of a *complete* fracture itself is the full separation of the bone fragments, irrespective of whether the skin is breached.
Choice D rationale
When the bone bends but does not break, this is characteristic of a bent bone deformity or an incomplete fracture, specifically a greenstick fracture common in pediatric patients due to the higher flexibility of their bones. This is not a complete fracture, where the bone's continuity is fully disrupted.
Correct Answer is C
Explanation
Choice A rationale
Emphasizing compliance without addressing the underlying emotional distress of an adolescent regarding body image can be counterproductive. Adherence to medical regimens, especially those affecting appearance, is significantly influenced by psychosocial factors and perceived stigma. A confrontational approach often increases resistance, hindering long-term treatment success.
Choice B rationale
Dismissing an adolescent's concern about peer perception trivializes their developmental stage, where social acceptance and body image are paramount. Telling them peers will not notice is often untrue and undermines trust, as adolescents are highly attuned to social cues and peer judgment, which can lead to further noncompliance.
Choice C rationale
Involving the adolescent in brace customization promotes autonomy and ownership over their treatment, significantly increasing compliance. This approach addresses the emotional impact of body image concerns by allowing for personalization, which can mitigate feelings of embarrassment and enhance self-esteem during a critical developmental period.
Choice D rationale
While explaining risks is important for informed consent, focusing solely on negative consequences without offering solutions or addressing emotional barriers can instill fear without promoting adherence. This approach can also lead to resentment or a feeling of being lectured, further alienating the adolescent from treatment.
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