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
Alendronate, a bisphosphonate, requires the client to remain upright for at least 30 minutes to facilitate gravitational transport of the medication through the esophagus and minimize esophageal irritation. This upright position helps prevent reflux and subsequent erosive esophagitis, a common adverse effect associated with delayed esophageal clearance and prolonged contact of the medication with the esophageal mucosa, ensuring safe drug delivery.
Choice B rationale
Taking alendronate with food significantly decreases its bioavailability due to chelation with various ions found in food, such as calcium and magnesium. This interaction forms insoluble complexes, reducing drug absorption from the gastrointestinal tract and consequently diminishing the therapeutic efficacy of the medication in inhibiting osteoclast activity and bone resorption.
Choice C rationale
Orange juice, being acidic, can further increase the risk of esophageal irritation when taken with alendronate. Furthermore, calcium fortified orange juice can bind to the medication, reducing its absorption. The acidic pH might also contribute to the degradation of the drug before it can be adequately absorbed, compromising its therapeutic effect on bone density.
Choice D rationale
Alendronate effervescent tablets are designed to be dissolved in water and swallowed as a solution. Chewing or sucking on the tablet can cause direct irritation to the oral mucosa and pharynx, leading to local tissue damage. This method also bypasses the intended rapid dissolution in water, potentially affecting proper absorption and increasing the risk of adverse gastrointestinal effects.
Correct Answer is A
Explanation
Choice A rationale
Dementia is a neurodegenerative disorder characterized by a progressive and irreversible decline in cognitive function, including memory, thinking, and reasoning. This deterioration is due to widespread neuronal loss and brain atrophy, leading to increasing dependence over time as the disease advances.
Choice B rationale
Dementia is not characterized by a sudden onset of confusion. Instead, its onset is typically insidious, with a gradual decline in cognitive abilities over months to years. A sudden onset of confusion is more indicative of delirium, which is an acute and often reversible state.
Choice C rationale
An altered level of consciousness is not typically associated with dementia. Clients with dementia generally maintain a clear level of consciousness, although they may experience confusion, disorientation, or difficulty with attention. Altered consciousness is a hallmark feature of delirium.
Choice D rationale
While high fever or dehydration can exacerbate cognitive impairment in individuals with underlying dementia, they do not trigger the development of dementia itself. These factors are more commonly associated with delirium, which is an acute confusional state, rather than the chronic progressive nature of dementia.
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