1. A nurse is working with a community group promoting healthy aging. What recommendation is best to help prevent osteoarthritis (OA)?
a. Avoid contact
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b. Get plenty of calcium.
c. Lose weight if needed. - Obesity can lead to OA, and if the client is overweight, losing weight can help prevent OA or reduce symptoms once it occurs
d. Engage in weight-bearing exercise.
2. 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) - . However, the first-line drug is acetaminophen
b. Cyclobenzaprine hydrochloride (Flexeril)
c. Hyaluronate (Hyalgan)
d. Ibuprofen (Motrin)
3. The clinic nurse assesses a client with diabetes during a checkup. The client also has osteoarthritis (OA). The nurse notes the clients 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? - OA, and glucosamine can increase blood glucose levels
c. How much exercise do you really get each week?
d. You’re still taking your diabetic medication, right?
4. 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 - Osteoporosis is a contraindication to joint replacement because the bones have a high risk of shattering as the new prosthesis is implanted
d. Urinary tract infection
5. 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 clients hands.
d. Use an abduction pillow. - To prevent the hip from dislocating, the nurse should use an abduction pillow since the client cannot follow directions at this time.
6. 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. - To prevent surgical wound infection, antibiotics are given preoperatively within an hour of surgery
b. Assess the clients white blood cell count.
c. Instruct the client to shower the night before.
d. Monitor the clients temperature postoperatively.
7. The nurse on the postoperative inpatient unit assesses a client after a total hip replacement. The clients 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. - Hip dislocation can cause neurovascular compromise. The nurse should assess neurovascular status, comparing 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.
8. 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. - Because the clients leg is strapped into the CPM, if it falls off the bed due to movement, the clients leg (and new joint) can be injured. The nurse should instruct the UAP to raise the siderail to prevent this from occurring
d. Remind the client to do quad-setting exercises.
9. 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 clients 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. - 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.
d. Palpate the clients bladder or perform a bladder scan.
10. 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 - As required by The Joint Commission and other accrediting agencies, a hand-off report must be given to the new provider to prevent error
11. 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 - the presence of one joint that is much redder, hotter, or more swollen that the other joints may indicate infection
c. Client who has a puffy-looking area behind the knee
d. Client with a worse joint deformity since the last visit
12. 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 clients chart.
c. Encourage range of motion of the neck.
d. Notify the provider immediately. - 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
13. 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 Sjgrens syndrome?
a. Abdominal assessment
b. Oxygen saturation
c. Renal function studies
d. Visual acuity - Sjgrens syndrome is seen in clients with RA and manifests with dryness of the eyes, mouth, and vagina in females. Visual disturbances can occur
14. 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 - 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
b. Has a positive outlook on life
c. Takes medication as directed
d. Uses assistive devices to protect joints
15. A client is started on etanercept (Enbrel). What teaching by the nurse is most appropriate?
a. Giving subcutaneous injections - Etanercept is given as a subcutaneous injection twice a week. The nurse should teach the client how to self- administer the medication.
b. Having a chest x-ray once a year
c. Taking the medication with food
d. Using heat on the injection site
16. 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) - Tofacitinib carries a FDA black box warning about opportunistic infections, tuberculosis, and cancer. Fever and cough may indicate tuberculosis.
17. 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 - Ice is best for acute inflammation
c. Splints
d. Wax dip
18. 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 - 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.
b. Platelet count: 210,000/mm3
c. Red blood cell count: 5.2/mm3
d. White blood cell count: 4400/mm3
19. 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. - 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.
b. Facilitate a consultation with physical therapy.
c. Measure the range of motion in both hips.
d. Notify the health care provider immediately.
20. A client with systemic lupus erythematosus (SLE) was recently discharged from the hospital after an acute exacerbation. The client is in the clinic for a follow-up visit and is distraught about the possibility of another hospitalization disrupting the family. What action by the nurse is best?
a. Explain to the client that SLE is an unpredictable disease.
b. Help the client create backup plans to minimize disruption. - SLE is an unpredictable disease and acute exacerbations can occur without warning, creating chaos in the family. Helping the client make backup plans for this event not only will decrease the disruption but will give the client a sense of having more control.
c. Offer to talk to the family and educate them about SLE.
d. Tell the client to remain compliant with treatment plans.
21. A nurse is caring for a client with systemic sclerosis (SSC). The clients facial skin is very taut, limiting the clients ability to open the mouth. After consulting with a registered dietitian for appropriate nutrition, what other consultation should the nurse facilitate?
a. Dentist - With limited ability to open the mouth, dental hygiene may be lacking. The nurse should encourage the client to see a dentist.
b. Massage therapist
c. Occupational therapy
d. Physical therapy
22. The nurse is teaching a client with gout dietary strategies to prevent exacerbations or other problems. Which statement by the nurse is most appropriate?
a. Drink 1 to 2 liters of water each day. - Kidney stones are common in clients with gout, so drinking plenty of water will help prevent this from occurring
b. Have 10 to 12 ounces of juice a day.
c. Liver is a good source of iron.
d. Never eat hard cheeses or sardines.
23. A nurse is teaching a client with psoriatic arthritis about the medication golimumab (Simponi). What information is most important to include?
a. Avoid large crowds or people who are ill. - This drug has a FDA black box warning about opportunistic or other serious infections. Teach the client to avoid large crowds and people who are ill.
b. Stay upright for 1 hour after taking this drug.
c. This drug may cause your hair to fall out.
d. You may double the dose if pain is severe.
24. A client in the orthopedic clinic has a self-reported history of osteoarthritis. The client reports a low-grade fever that started when the weather changed and several joints started acting up, especially both hips and knees. What action by the nurse is best?
a. Assess the client for the presence of subcutaneous nodules or Bakers cysts. - Osteoarthritis is not a systemic disease, nor does it present bilaterally. These are manifestations of rheumatoid arthritis. The nurse should assess for other manifestations of this disorder, including subcutaneous nodules and Bakers cysts.
b. Inspect the clients feet and hands for podagra and tophi on fingers and toes.
c. Prepare to teach the client about an acetaminophen (Tylenol) regimen.
d. Reassure the client that the problems will fade as the weather changes again.
25. A nurse is caring for a client after joint replacement surgery. What action by the nurse is most important to prevent wound infection?
a. Assess the clients white blood cell count.
b. Culture any drainage from the wound.
c. Monitor the clients temperature every 4 hours.
d. Use aseptic technique for dressing changes. - Preventing surgical wound infection is a primary responsibility of the nurse, who must use aseptic technique to change dressings or empty drains.
26. A nurse is discharging a client after a total hip replacement. What statement by the client indicates good potential for self-management?
a. I can bend down to pick something up.
b. I no longer need to do my exercises.
c. I will not sit with my legs crossed. - There are many precautions clients need to take after hip replacement surgery, including not bending more than 90 degrees at the hip
d. I wont wash my incision to keep it dry.
27. The nurse is caring for a client using a continuous passive motion (CPM) machine and has delegated some tasks to the unlicensed assistive personnel (UAP). What action by the UAP warrants intervention by the nurse?
a. Checking to see if the machine is worki [Show Less]