Ch. 18 Flashcards
A nurse is working with a community group promoting healthy aging. What recommendation is best to help prevent osteoarthritis (OA)?
a.
Avoid contact sports.
b.
Get plenty of calcium.
c.
Lose weight if needed.
d.
Engage in weight-bearing exercise.
ANS: C
Obesity can lead to OA, and if the client is overweight, losing weight can help prevent OA or reduce symptoms once it occurs. Arthritis can be caused by contact sports, but this is less common than obesity. Calcium and weight-bearing exercise are both important for osteoporosis.
DIF: Understanding/Comprehension REF: 294
A nurse in the family clinic is teaching a client newly diagnosed with osteoarthritis (OA) about drugs used to treat the disease. For which medication does the nurse plan primary teaching?
a.
Acetaminophen (Tylenol)
b.
Cyclobenzaprine hydrochloride (Flexeril)
c.
Hyaluronate (Hyalgan)
d.
Ibuprofen (Motrin)
ANS: A
All of the drugs are appropriate to treat OA. However, the first-line drug is acetaminophen. Cyclobenzaprine is a muscle relaxant given to treat muscle spasms. Hyaluronate is a synthetic joint fluid implant. Ibuprofen is a nonsteroidal anti-inflammatory drug.
DIF: Remembering/Knowledge REF: 293
The clinic nurse assesses a client with diabetes during a checkup. The client also has osteoarthritis (OA). The nurse notes the client’s blood glucose readings have been elevated. What question by the nurse is most appropriate?
a.
“Are you compliant with following the diabetic diet?”
b.
“Have you been taking glucosamine supplements?”
c.
“How much exercise do you really get each week?”
d.
“You’re still taking your diabetic medication, right?”
ANS: B
All of the topics are appropriate for a client whose blood glucose readings have been higher than usual. However, since this client also has OA, and glucosamine can increase blood glucose levels, the nurse should ask about its use. The other questions all have an element of nontherapeutic communication in them. “Compliant” is a word associated with negative images, and the client may deny being “noncompliant.” Asking how much exercise the client “really” gets is accusatory. Asking if the client takes his or her medications “right?” is patronizing.
DIF: Applying/Application REF: 295
The nurse working in the orthopedic clinic knows that a client with which factor has an absolute contraindication for having a total joint replacement?
a.
Needs multiple dental fillings
b.
Over age 85
c.
Severe osteoporosis
d.
Urinary tract infection
ANS: C
Osteoporosis is a contraindication to joint replacement because the bones have a high risk of shattering as the new prosthesis is implanted. The client who needs fillings should have them done prior to the surgery. Age greater than 85 is not an absolute contraindication. A urinary tract infection can be treated prior to surgery.
DIF: Remembering/Knowledge REF: 295
An older client has returned to the surgical unit after a total hip replacement. The client is confused and restless. What intervention by the nurse is most important to prevent injury?
a.
Administer mild sedation.
b.
Keep all four siderails up.
c.
Restrain the client’s hands.
d.
Use an abduction pillow.
ANS: D
Older clients often have trouble metabolizing anesthetics and pain medication, leading to confusion or restlessness postoperatively. To prevent the hip from dislocating, the nurse should use an abduction pillow since the client cannot follow directions at this time. Sedation may worsen the client’s mental status and should be avoided. Using all four siderails may be considered a restraint. Hand restraints are not necessary in this situation.
DIF: Applying/Application REF: 297
What action by the perioperative nursing staff is most important to prevent surgical wound infection in a client having a total joint replacement?
a.
Administer preoperative antibiotic as ordered.
b.
Assess the client’s white blood cell count.
c.
Instruct the client to shower the night before.
d.
Monitor the client’s temperature postoperatively.
ANS: A
To prevent surgical wound infection, antibiotics are given preoperatively within an hour of surgery. Simply taking a shower will not help prevent infection unless the client is told to use special antimicrobial soap. The other options are processes to monitor for infection, not prevent it.
DIF: Applying/Application REF: 296
The nurse on the postoperative inpatient unit assesses a client after a total hip replacement. The client’s surgical leg is visibly shorter than the other one and the client reports extreme pain. While a co-worker calls the surgeon, what action by the nurse is best?
a.
Assess neurovascular status in both legs.
b.
Elevate the affected leg and apply ice.
c.
Prepare to administer pain medication.
d.
Try to place the affected leg in abduction.
ANS: A
This client has manifestations of hip dislocation, a critical complication of this surgery. Hip dislocation can cause neurovascular compromise. The nurse should assess neurovascular status, comparing both legs. The nurse should not try to move the extremity to elevate or abduct it. Pain medication may be administered if possible, but first the nurse should thoroughly assess the client.
DIF: Applying/Application REF: 297
A client has a continuous passive motion (CPM) device after a total knee replacement. What action does the nurse delegate to the unlicensed assistive personnel (UAP) after the affected leg is placed in the machine while the client is in bed?
a.
Assess the distal circulation in 30 minutes.
b.
Change the settings based on range of motion.
c.
Raise the lower siderail on the affected side.
d.
Remind the client to do quad-setting exercises.
ANS: C
Because the client’s leg is strapped into the CPM, if it falls off the bed due to movement, the client’s leg (and new joint) can be injured. The nurse should instruct the UAP to raise the siderail to prevent this from occurring. Assessment is a nursing responsibility. Only the surgeon, physical therapist, or specially trained technician adjusts the CPM settings. Quad-setting exercises are not related to the CPM machine.
DIF: Applying/Application REF: 301
After a total knee replacement, a client is on the postoperative nursing unit with a continuous femoral nerve blockade. On assessment, the nurse notes the client’s pulses are 2+/4+ bilaterally; the skin is pale pink, warm, and dry; and the client is unable to dorsiflex or plantarflex the affected foot. What action does the nurse perform next?
a.
Document the findings and monitor as prescribed.
b.
Increase the frequency of monitoring the client.
c.
Notify the surgeon or anesthesia provider immediately.
d.
Palpate the client’s bladder or perform a bladder scan.
ANS: C
With the femoral nerve block, the client should still be able to dorsiflex and plantarflex the affected foot. Since this client has an abnormal finding, the nurse should notify either the surgeon or the anesthesia provider immediately. Documentation is the last priority. Increasing the frequency of assessment may be a good idea, but first the nurse must notify the appropriate person. Palpating the bladder is not related.
DIF: Applying/Application REF: 302
A nurse is discharging a client to a short-term rehabilitation center after a joint replacement. Which action by the nurse is most important?
a.
Administering pain medication before transport
b.
Answering any last-minute questions by the client
c.
Ensuring the family has directions to the facility
d.
Providing a verbal hand-off report to the facility
ANS: D
As required by The Joint Commission and other accrediting agencies, a hand-off report must be given to the new provider to prevent error. The other options are valid responses but do not take priority.
DIF: Applying/Application REF: 304
A nurse works in the rheumatology clinic and sees clients with rheumatoid arthritis (RA). Which client should the nurse see first?
a.
Client who reports jaw pain when eating
b.
Client with a red, hot, swollen right wrist
c.
Client who has a puffy-looking area behind the knee
d.
Client with a worse joint deformity since the last visit
ANS: B
All of the options are possible manifestations of RA. However, the presence of one joint that is much redder, hotter, or more swollen that the other joints may indicate infection. The nurse needs to see this client first.
DIF: Applying/Application REF: 305
A client with rheumatoid arthritis (RA) is on the postoperative nursing unit after having elective surgery. The client reports that one arm feels like “pins and needles” and that the neck is very painful since returning from surgery. What action by the nurse is best?
a.
Assist the client to change positions.
b.
Document the findings in the client’s chart.
c.
Encourage range of motion of the neck.
d.
Notify the provider immediately.
ANS: D
Clients with RA can have cervical joint involvement. This can lead to an emergent situation in which the phrenic nerve is compressed, causing respiratory insufficiency. The client can also suffer a permanent spinal cord injury. The nurse needs to notify the provider immediately. Changing positions and doing range of motion may actually worsen the situation. The nurse should document findings after notifying the provider.
DIF: Applying/Application REF: 306
The nurse working in the rheumatology clinic is seeing clients with rheumatoid arthritis (RA). What assessment would be most important for the client whose chart contains the diagnosis of Sjögren’s syndrome?
a.
Abdominal assessment
b.
Oxygen saturation
c.
Renal function studies
d.
Visual acuity
ANS: D
Sjögren’s syndrome is seen in clients with RA and manifests with dryness of the eyes, mouth, and vagina in females. Visual disturbances can occur. The other assessments are not related to RA and Sjögren’s syndrome.
DIF: Applying/Application REF: 306
The nurse is working with a client who has rheumatoid arthritis (RA). The nurse has identified the priority problem of poor body image for the client. What finding by the nurse indicates goals for this client problem are being met?
a.
Attends meetings of a book club
b.
Has a positive outlook on life
c.
Takes medication as directed
d.
Uses assistive devices to protect joints
ANS: A
All of the activities are appropriate for a client with RA. Clients who have a poor body image are often reluctant to appear in public, so attending public book club meetings indicates that goals for this client problem are being met.
DIF: Evaluating/Synthesis REF: 312
A client is started on etanercept (Enbrel). What teaching by the nurse is most appropriate?
a.
Giving subcutaneous injections
b.
Having a chest x-ray once a year
c.
Taking the medication with food
d.
Using heat on the injection site
ANS: A
Etanercept is given as a subcutaneous injection twice a week. The nurse should teach the client how to self-administer the medication. The other options are not appropriate for etanercept.
DIF: Understanding/Comprehension REF: 310
The nurse in the rheumatology clinic is assessing clients with rheumatoid arthritis (RA). Which client should the nurse see first?
a.
Client taking celecoxib (Celebrex) and ranitidine (Zantac)
b.
Client taking etanercept (Enbrel) with a red injection site
c.
Client with a blood glucose of 190 mg/dL who is taking steroids
d.
Client with a fever and cough who is taking tofacitinib (Xeljanz)
ANS: D
Tofacitinib carries a Food and Drug Administration black box warning about opportunistic infections, tuberculosis, and cancer. Fever and cough may indicate tuberculosis. Ranitidine is often taken with celecoxib, which can cause gastrointestinal distress. Redness and itchy rashes are frequently seen with etanercept injections. Steroids are known to raise blood glucose levels.
DIF: Applying/Application REF: 311
A client with rheumatoid arthritis (RA) has an acutely swollen, red, and painful joint. What nonpharmacologic treatment does the nurse apply?
a.
Heating pad
b.
Ice packs
c.
Splints
d.
Wax dip
ANS: B
Ice is best for acute inflammation. Heat often helps with joint stiffness. Splinting helps preserve joint function. A wax dip is used to provide warmth to the joint which is more appropriate for chronic pain and stiffness.
DIF: Remembering/Knowledge REF: 311
The nurse on an inpatient rheumatology unit receives a hand-off report on a client with an acute exacerbation of systemic lupus erythematosus (SLE). Which reported laboratory value requires the nurse to assess the client further?
a.
Creatinine: 3.9 mg/dL
b.
Platelet count: 210,000/mm3
c.
Red blood cell count: 5.2/mm3
d.
White blood cell count: 4400/mm3
ANS: A
Lupus nephritis is the leading cause of death in clients with SLE. The creatinine level is very high and the nurse needs to perform further assessments related to this finding. The other laboratory values are normal.
DIF: Applying/Application REF: 314
A client who has had systemic lupus erythematosus (SLE) for many years is in the clinic reporting hip pain with ambulation. Which action by the nurse is best?
a.
Assess medication records for steroid use.
b.
Facilitate a consultation with physical therapy.
c.
Measure the range of motion in both hips.
d.
Notify the health care provider immediately.
ANS: A
Chronic steroid use is seen in clients with SLE and can lead to osteonecrosis (bone necrosis). The nurse should determine if the client has been taking a steroid. Physical therapy may be beneficial, but there is not enough information about the client yet. Measuring range of motion is best done by the physical therapist. Notifying the provider immediately is not warranted.
DIF: Applying/Application REF: 315
