A nurse is caring for a client who has acute osteomyelitis.
Which of the following interventions is the nurse's priority?
Increase the client's protein intake.
Administer antibiotics to the client.
Teach relaxation breathing to reduce the client's pain.
Provide the client with antipyretic therapy.
The Correct Answer is B
Choice A rationale
While increased protein intake is beneficial for tissue repair and overall healing, it is not the immediate priority in acute osteomyelitis. The primary concern is eradicating the bacterial infection, which causes systemic inflammation and bone destruction. Nutritional support is supportive therapy, not the initial life-saving intervention.
Choice B rationale
Acute osteomyelitis is a severe bone infection, often bacterial. Administering antibiotics directly targets the causative microorganisms, preventing further bone destruction, systemic sepsis, and potentially life-threatening complications. Prompt antimicrobial therapy is crucial for controlling the infection and preserving bone integrity, making it the highest priority intervention.
Choice C rationale
Pain management is important in osteomyelitis, but teaching relaxation breathing, while helpful for comfort, does not address the underlying pathology. The infection itself poses a greater immediate threat than the pain. Effective pain relief often follows successful treatment of the infection and reduction of inflammation.
Choice D rationale
Antipyretic therapy addresses fever, a symptom of infection, but does not treat the infection itself. While important for comfort and reducing metabolic demands, it is a supportive measure. The priority is to eliminate the bacterial pathogen causing the fever and bone destruction through targeted antibiotic therapy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Rheumatoid arthritis is a chronic autoimmune inflammatory disease that commonly affects the small joints of the hands and feet bilaterally and symmetrically. Characteristic late-stage findings include ulnar deviation of the fingers, swan-neck deformities (hyperextension of the PIP joint and flexion of the DIP joint), and boutonnière deformities (flexion of the PIP joint and hyperextension of the DIP joint) due to chronic synovial inflammation.
Choice B rationale
Osteoarthritis is a degenerative joint disease characterized by cartilage breakdown, primarily affecting weight-bearing joints but also the hands. Hand findings include Heberden's nodes (DIP joints) and Bouchard's nodes (PIP joints), which are bony enlargements. Unlike rheumatoid arthritis, osteoarthritis is typically asymmetrical and lacks significant inflammation.
Choice C rationale
Gout is a form of inflammatory arthritis caused by uric acid crystal deposition in joints. While it can affect the hands, it most commonly presents as acute, severe pain, swelling, and redness in a single joint, often the great toe. Chronic gout can lead to tophi, which are visible urate deposits, but not the specific deformities seen in rheumatoid arthritis.
Choice D rationale
Paget's disease of bone is a chronic disorder characterized by abnormal bone remodeling, leading to enlarged and misshapen bones. It primarily affects the skull, spine, pelvis, and long bones of the extremities. Hand involvement is uncommon and does not typically result in the characteristic joint deformities seen in the scenario.
Correct Answer is B
Explanation
Choice A rationale
Methotrexate does not have a significant interaction with vitamin K. Methotrexate's primary mechanism of action involves inhibiting dihydrofolate reductase, thereby interfering with folate metabolism and DNA synthesis. Vitamin K is crucial for blood clotting factors. There is no contraindication for vitamin K rich foods.
Choice B rationale
Methotrexate excretion is primarily renal, and adequate hydration is critical to prevent nephrotoxicity and facilitate drug elimination. Drinking at least 2 liters of water daily helps maintain good kidney function, ensuring that methotrexate and its metabolites are efficiently cleared from the body, thus minimizing the risk of drug accumulation and associated toxicities.
Choice C rationale
Methotrexate for rheumatoid arthritis is typically administered once weekly, not daily, to mitigate severe adverse effects such as bone marrow suppression, hepatotoxicity, and gastrointestinal complications. Daily dosing would lead to rapid accumulation and dangerously high systemic concentrations, overwhelming the body's detoxification pathways.
Choice D rationale
Alcohol-based mouthwashes should be avoided when taking methotrexate because alcohol can cause mucosal irritation and increase the risk of oral mucositis, a common side effect of methotrexate. Additionally, alcohol can exacerbate hepatotoxicity, a significant concern with methotrexate therapy, by increasing metabolic burden on the liver.
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