Q/exp contains pharm Q gout **REVIEW** Practice week 5

A nurse is teaching a client who has RA about self-care strategies for managing the disease. Which of the following activities should the nurse include in the teaching?

A: Press water from a sponge rather than wringing it. R: The nurse should instruct the client to modify fine motor activities, such as wringing out a sponge, by using larger joints or body surfaces, such as the palm of the hand, to substitute for smaller ones.

A nurse in the ED is caring for a client who is bleeding profusely from a deep laceration on his left lower forearm. After observing standard precautions, which of the following actions should the nurse perform first?

A: Apply direct pressure over the wound. R: The greatest risk to the client is injury from hemorrhage. Therefore, the first action the nurse should take is to apply firm pressure with a thick, dry dressing material directly over the wound to stop bleeding.

A nurse is caring for a client who has a pelvic fracture. The client reports sudden SOB, stabbing chest pain, and feelings of doom. The nurse should identify that the client is experiencing which of the following complications?

A: Pulmonary embolus R: Immobility following musculoskeletal trauma places the client at an increased risk for pulmonary embolus. The client might also exhibit tachycardia, chest petechiae, and have a decreased SaO2. The nurse should notify the rapid response team immediately.

A nurse is performing medication reconciliation for a newly admitted client who has RA. Which of the following medications should the nurse identify as the treatment for this condition?

A: Celecoxib R: Celecoxib is a type of NSAID, called cyclooxygenase-2 (COX-2) inhibitors, used to relieve some of the manifestations caused by RA in adults. The nurse should identify that the medication is also prescribed for osteoarthritis, spondylitis, and painful menstruation.

A nurse is teaching a client who is starting to take methotrexate to treat RA. Which of the following instructions should the nurse include in the teaching?

A: Drink at least 2 liters of water daily R: The client should drink 2 to 3 L of water per day because methotrexate can cause kidney damage. Adequate hydration optimizes drug excretion and helps prevent renal damage.

A nurse is providing pre-op teaching for a client who is scheduled for total knee arthroplasty. Which of the following statements by the client should the nurse identify as understanding of the teaching?

A: I should wear elastic stockings on both of my legs. R: The purpose of elastic stockings is to prevent venous thromboembolism, which is a common complication following orthopedic surgery. Therefore, the nurse should identify this statement as understanding of the teaching.

A nurse in a medical clinic is providing teaching to an older adult client who has OA that is affecting her knees. Which of the following client statements indicates an understanding of the teaching?

A: "I can use either heat or ice to help relieve my discomfort" R: The nurse should reinforce that different treatment modalities, such as heat or cold therapy, can be tried to determine which one is more effective for the client. Heat application can help with muscle relaxation in the area around the affected joint. The application of cold numbs nerve endings and decreases joint inflammation.

A nurse is preparing a presentation at a community center about OA. The nurse should plan to include which of the following information?SATA

A: Affects weight-bearing joints. crepitus can occur in affected joints, causes joint stiffness, causes joint pain. R: Affects weight-bearing joints is correct. Stress from the use of weight bearing joints can result in joint degeneration and osteoarthritis. Crepitus can occur in affected joints is correct. Clients who have osteoarthritis can develop crepitus, or a grating sound, caused by friction in the joints. Affects bilateral, symmetrical joints is incorrect. Rheumatoid arthritis occurs in bilateral symmetrical joints. Causes joint stiffness is correct. Clients who have osteoarthritis have chronic joint stiffness. Causes joint pain is correct. Clients who have osteoarthritis have chronic joint pain.

A nurse is teaching a client about risk factors for OA. Which of the following factors should the nurse include in the teaching? SATA

A: Aging, Obesity, Smoking R: Bacteria is incorrect. Bacterial infections can lead to infectious arthritis, which does not cause irreversible damage to joints. Infection is not a risk factor for osteoarthritis. Diuretics is incorrect. Diuretic therapy is a possible risk factor for gout, but not for osteoarthritis. Aging is correct. Aging is a risk factor for osteoarthritis, as the joints bear the load of the body's weight over time. Obesity is correct. Obesity is a risk factor for osteoarthritis, as it increases the load of the body's weight over time. Smoking is correct. Smoking is a risk factor for osteoarthritis, as smoking predisposes people to the loss of cartilage in the knees.

A nurse is caring for a client who is post-op following a total knee arthroplasty and is prescribed a continuous passive motion (CPM) machine and PCA. The client tells the nurse, " I am in so much pain." Which of the following actions should the nurse take first?

A: Ask the client to describe the characteristics of the pain R: Answering this item requires application of the nursing process priority-setting framework. The nurse can use the nursing process to plan client care and prioritize nursing actions. Each step of the nursing process builds on the previous step, beginning with assessment or data collection. Before the nurse can formulate a plan of action, implement a nursing intervention, or notify a provider of a change in the client's status, she must first collect adequate data from the client. Assessing or collecting additional data will provide the nurse with knowledge to make an appropriate decision. Therefore, the first action the nurse should take is to acquire further data by asking the client to describe the characteristics of the pain.

A nurse is reviewing the medical record of a client who has a prescription for probenecid to treat gout. The nurse should identify that which of the following medications can interact with probenecid?

A: Aspirin R: Aspirin can decrease the effectiveness of probenecid. The nurse should caution the client to avoid interaction between probenecid and salicylate medications.

A nurse is preparing dietary instructions for a client who has episodes of biliary colic from chronic cholecystitis. Which of the following instructions should the nurse include in the teaching plan?

A: Avoids foods high in fat R: The nurse should instruct the client to follow a low-fat diet to decrease episodes of biliary colic. A client who has chronic cholecystitis has intolerance to fatty foods.

A client is starting celecoxib to treat OA. The nurse should instruct the client to watch for and report which of the following adverse effects?

A: Black, tarry stools R: Celecoxib can cause gastrointestinal bleeding. The client should watch for and report black, dark-colored, or bloody stools, abdominal pain, or coffee-ground emesis. The nurse also should instruct the client to take celecoxib with food to reduce gastric irritation.

A nurse is teaching a client who is to begin long-term therapy with prednisone to treat RA. The nurse should instruct the client to take which of the following supplements while taking this medication?

A: Calcium and vit D R: Long-term use of glucocorticoids, such as prednisone, places the client at risk for osteoporosis. The nurse should instruct the client to take calcium and vitamin D supplements to reduce this risk.

A nurse in a provider's clinic is assessing a client who has cancer and a prescription for methotrexate PO. Which of the following actions should the nurse take when the client reports bleeding gums?

A: Check the value of the client's current platelet count. R: The nurse should recognize that the bleeding is likely due to the adverse effect of the chemotherapy and needs to be evaluated further. Bleeding gums is a sign of thrombocytopenia (decreased platelet count) secondary to bone marrow suppression, which can be life-threatening in a client who is receiving chemotherapy.

A nurse is teaching a client who has a new prescription for prednisone to treat RA. The nurse should inform the client that which of the following is a therapeutic effect of this medication?

A: Decreases inflammation R: Prednisone is used to treat rheumatoid arthritis because it produces anti-inflammatory and immunosuppressive effects, which reduces inflammation, decreases pain, and increases mobility.

A nurse is providing teaching a client who has RA and a new prescription for methotrexate. Which of the following instructions should the nurse include? SATA

A: Do not drink alcoholic beverages while taking this med; report unexplained bruising while taking this med; avoid people who have infections. R: Expect to feel the medication's effects immediately is incorrect. It may take 3 to 6 weeks to achieve the medication's therapeutic effects. Do not drink alcoholic beverages while taking this medication is correct. Alcohol ingestion can increase the risk of liver damage. Report unexplained bruising to the provider is correct. Methotrexate can cause thrombocytopenia. Clients should report bruising or petechiae as they may indicate a low platelet count. Avoid people who have infections is correct. Methotrexate causes bone marrow suppression and increases the risk for infection. Take NSAIDs to help minimize the adverse effects of the medication is incorrect. NSAIDs interact with methotrexate and should be avoided. Providers sometimes prescribe folic acid to help minimize the side effects of methotrexate.

A nurse is teaching a client who has RA about taking methotrexate. Which of the following information should the nurse include?

A: Drink 2 to 3 L of water per day. R: Methotrexate can cause renal toxicity. The client should drink 2 to 3 L of water per day to promote excretion of the medication.

A nurse is caring for a client who post-op following an open cholecystectomy. Which of the following actions should the nurse taken when caring for the client's Jackson-Pratt (JP) drain?

A: Expel the air from the JP bulb after emptying to re-establish suction. R: With the drainage and the air removed and the bulb tightly closed, the system works to exert gentle negative pressure, facilitating the removal of accumulated fluid from the surgical area.

A nurse in the ED is assessing a client who was in a motor-vehicle crash 2 day ago and sustained fractures to his tibia, ulna, and several ribs. The client is now disoriented to time and place, has a SaO2 of 87%, and the nurse notes generalized petechiae on the client's skin. Which of the following complication should the nurse suspect?

A: Fat embolism sydrome R: The nurse should identify the triad of neurologic changes, petechial rash, and hypoxemia as findings of fat embolism syndrome. Risk factors include multiple fractures and fracture of a long bone. Male clients are also at greater risk. The manifestations occur when fat globules occlude small blood vessels.

A nurse is assessing a client for early manifestations of RA. Which of the following changes is an early manifestation of RA?

A: Fatigue R: Fatigue, weakness, and anorexia are early manifestations of RA.

A nurse is caring for a client who has OA and asks about the use of glucosamine. Which of the following statements should the nurse make? SATA

A: Glucosamine might increase bleeding; Glucosamine can increase blood glucose levels; clients who have shellfish allergies might experience reactions when taking glucosamine. R: Glucosamine alone or when taken with chondroitin can increase the risk of bleeding in clients who are taking anticoagulants or antiplatelet medications. The nurse should instruct the client to discuss the use of glucosamine with her provider to prevent interactions.

A nurse is caring for a client who is in skeletal traction following a femur fracture. The nurse finds the client has slid down towards the door of the bed and the traction weight is resting on the floor. Which of the following actions should the nurse take?

A: Have the client use a trapeze to pull himself up while ensuring the weight hangs freely. R: The nurse should ensure that traction weight is hanging freely. The client can use an overhead trapeze bar to move up in bed, or the nurse can assist the client up, making sure to maintain proper alignment of the extremity.

A nurse is reviewing the medical record of a female client. Which of the following findings should the nurse identify as a risk factor for osteoporosis?

A: History of anorexia nervosa R: The nurse should identify anorexia nervosa as a risk factor for osteoporosis. Inadequate protein intake can lead to a decreased bone density, increasing the risk for fractures.

A nurse is caring for a client who post-op following shoulder surgery. The client has a prescription to keep affected arm adducted. Which of the following instructions should the nurse provide the client?

A: Hold your arm against the side of your body R: Adduction means to position toward the midline of the body. Therefore, the nurse should provide these instructions to explain the provider's prescription.

A nurse is reviewing d/c instructions with a client who has RA and a new prescription for prednisone. Which of the following statements by the client indicates an understanding of the teaching?

A: I should eat more bananas while taking this med R: The nurse should instruct the client to eat more potassium-rich foods such as bananas and citrus fruits while taking this medication. Prednisone can cause a loss of potassium, and the nurse should instruct the about the manifestations of hypokalemia such as muscle weakness and cramping and to notify the provider should these occur.

A nurse is caring for a client who returns to the nursing unit from recovery room after a sigmoid colon resection for adenocarcinoma. The client had an episode of intraoperative bleeding. Which finding indicates to the nurse that the client may be developing hypovolemic shock?

A: Increase in the heart rate from 88 to 110/min R: Hypovolemic shock is a condition in which the heart is unable to supply enough blood to the body because of blood loss or inadequate blood volume. In an effort to compensate for this, the heart rate increases steadily. In the first stage of shock (compensatory), the heart rate is > 100/min. As shock progresses, the heart rate continues to accelerate to more than 150/min. In the final (irreversible or refractory) stage, the heart rate becomes very erratic and may develop asystole.

A nurse is teaching a client who has a new prescription for cyclosporine oral solution to treat RA. Which of the following information should the nurse include in the teaching?

A: Mix with chocolate milk R: The client may combine cyclosporine with milk, chocolate milk, or orange juice to make the medication more palatable.

A nurse is discussing the difference between RA and OA with a newly licensed nurse. Which of the following information should the nurse include about OA?

A: OA can impair a joint on a single side of the body R: The nurse should identify unilateral joint involvement as a finding of osteoarthritis. A client who has RA experiences symmetrical joint impairment.

A nurse is caring for a client who has RA and is experiencing difficulty feeding herself using adaptive devices. The nurse should initiate a referral to which of the following members of the interprofessional health care team?

A: Occupational therapist R: An occupational therapist assists clients who have physical challenges to use adaptive devices and strategies to help with self-care activities such as feeding.

A nurse is caring for a client who is post-op following a cholecystectomy and reports pain. Which of the following actions should the nurse take? SATA

A: Offer the client a back rub; remind the client to use incisional splinting; identify the clients pain level, change the clients position. R: Offer the client a back rub is correct. Nonpharmacological comfort measures can improve pain management. Remind the client to use incisional splinting is correct. Holding a pillow against the incision when moving, turning, or coughing can help the client with self-management of pain. Identify the client's pain level is correct. The nurse should use a standard scale to determine and document the severity of the client's pain. Assist the client to ambulate is incorrect. If the client reports pain, the nurse should implement interventions to manage the pain, such as administering analgesia and giving it time to take effect, before assisting the client to ambulate. Change the client's position is correct. Nonpharmacological measures for managing pain include repositioning, imagery, and distraction.

A nurse is admitting a client to the surgical unit from the PACU following a cholecystectomy. Which of the following assessments is the nurse's priority?

A: Oxygen Saturation R: The priority action the nurse should take when using the airway, breathing, circulation approach to client care is to assess the client's oxygen saturation. The nurse should check the client's airway, listen to the client's breath sounds, and check the client's pulse oximetry to assess for respiratory depression.

A nurse is completing a physical assessment of a client who has early OA. Which of the following manifestations should the nurse expect?

A: Pain worsens with activity R: The typical cycle of pain and relief in a client who has early osteoarthritis consists of pain with activity and pain relief with rest. As the disorder progresses, clients typically experience pain even while the joint is at rest.

A nurse is caring for a client immediately following application of a plaster cast. The nurse should monitor for and report which of the following findings as an indication of compartment syndrome?

A: Paresthesias of the extremity R: The nurse should identify paresthesias as a finding of compartment syndrome. Compartment syndrome involves the compression of nerves and blood vessels in an enclosed space, leading to impaired blood flow and nerve damage. Other findings include numbness, tingling, weakness, and pain that does not respond to medication.

A nurse is admitting a client who is at 36 weeks gestation and has painless, bright red vaginal bleeding. The nurse should recognize this finding as an indication of which of the following conditions?

A: Placenta previa R: Painless, bright red vaginal bleeding in the second or third trimester is a manifestation of placenta previa.

A nurse is caring for a client who was admitted with bleeding esophageal varies and has an esophagogastric balloon tamponade with a Sengstaken-Blakemore tube to control the bleeding. Which of the following actions should the nurse take?

A: Provide frequent oral and nares care. R: A client who has a Sengstaken-Blakemore tube in place is unable to swallow. If the client is alert, the nurse should encourage the client to spit saliva into a tissue or basin. If the client is not alert, gentle suctioning of the oral cavity and nares might be required to remove secretions.

A nurse is caring for a female client who has RA and a new prescription for methotrexate. The client tells the nurse she is planning a pregnancy. Which of the following instruction should the nurse give the client?

A: The med should be discontinued 3 months prior to a planned pregnancy. R: Methotrexate should be discontinued 3 months prior to planning a pregnancy because of the risk of birth defects.

A nurse is assessing a client who is 48hr post-op following open reduction and internal fixation of a fractured tibia. Which of the following findings should the nurse report to the provider?

A: Toes cold to the touch R: The nurse should monitor for and report manifestations of compartment syndrome following internal fixation. Therefore, the nurse should contact the provider immediately if the client's toes are cold to the touch.

A nurse is caring for a client who had a fiberglass cast placed on her left arm several hours ago and now reports itching under the cast. Which of the following actions should the nurse plan to take?

A: Use a hair dryer on a cool setting to blow air into the cast R: The nurse should provide relief for the report of itching by blowing cool air into the cast using a hair dryer on a cool setting or an empty 60-mL plunger syringe.

A nurse is providing teaching to a client who has a new prescription for hydroxychloroquine to treat mild manifestations of RA. Which of the following information should the include in the teaching?

A: Wear sunglasses when out in the bright sunshine. R: The nurse should instruct the client to wear sunglasses to decrease photophobia when taking hydroxychloroquine. Clients should have an ophthalmologic examination before treatment because the medication can cause retinopathy.

A nurse is discussing the plan of care with a client who has osteomyelitis of an open wound on his heel. Which of the following informations should the nurse include?

A: Your provider might prescribe a center catheter line for long-term antibiotic therapy R: Osteomyelitis is an acute or chronic bone infection. The client will require weeks to months of IV antibiotic therapy for treatment. Therefore, the nurse should discuss the need for long-term IV access for antibiotic therapy.

Administer naproxen 500mg PO BID for OA. Available 124mg/5mL. How many mL do you admin.?

20mL

A nurse is caring for a client who has a GI bleeding. Which of the following actions should the nurse take first?

A: Assess orthostatic blood pressure R: Using the nursing process, the first action the nurse should take is to assess the client by measuring the client's orthostatic blood pressure. This action determines if the client is hypovolemic and establishes a baseline for further measurements.

A nurse is providing teaching to a client who has RA and a new prescription for methotrexate. Which of the following should the nurse include in the teaching?

A: Avoid crowds R: The nurse should instruct the client to avoid crowds when taking methotrexate. Methotrexate can cause leukopenia due to bone marrow suppression, which can increase the client's risk for infection.

A nurse is teaching a client who has a new prescription for aspirin to treat RA. The nurse should include to monitor for which of the following adverse effects of this medication?

A: Bleeding R: Aspirin can cause bleeding, tinnitus, gastric ulceration, nausea, and heartburn. The client should monitor and report manifestations of bleeding, such as black tarry stools.

A nurse is providing d/c instructions for a client who is post-op following inner maxillary fixation with wiring. Which of the following information should the nurse include?

A: Cut the wiring if emesis occurs R: Inner maxillary fixation involves wiring of the teeth to support the fractured jaw by holding the jawbones together. The wires are left in place until the fracture is healed. To preserve the client's airway, the nurse should instruct the client to have wire cutters available to immediately cut wiring if emesis occurs. The client should return to the provider as soon as possible for re-wiring.

A nurse is caring for a client who has suspected cholecystitis. The nurse should expect the client's ruin to appear which of the following colors?

A: Dark and foamy R: The nurse should expect the client to have dark and foamy urine, which indicates the kidneys are filtering excess bilirubin from the blood.

A nurse is caring for a client who has liver cirrhosis with ascites, bleeding esophageal varies, and portal hypertension. The nurse recognizes which of the following lab findings as indicating the client GI tract is digesting and absorbing?

A: Elevated blood urea nitrogen (BUN) R: As the body digests blood, BUN rises. An elevated BUN is an indication of GI bleeding.

A nurse is providing care for a client who had a laparoscopic cholecystectomy. Which of the following is an appropriate nursing action?

A: Encourage ambulation once fully awake. R: The nurse should instruct the client to follow a low-fat diet to decrease episodes of biliary colic. A client who has chronic cholecystitis has intolerance to fatty foods.

A nurse is caring for an older adult client who has RA and is taking aspirin 650mg every 4 hours. Which of the following diagnostics tests should the nurse monitor to evaluate the effectiveness of this medication?

A: Erythrocyte sedimentation rate (ESR) R: Rheumatoid arthritis is a chronic inflammatory disease. ESR is useful in detecting and monitoring tissue inflammation in clients with RA. As the disease improves the ESR decreases.

A nurse in a provider's office is assessing a client who has RA. Which of the following findings is a late manifestation of this condition?

A: Knuckle deformity R: Joint deformity is a late manifestation of RA.

A nurse is caring for a client who has bleeding esophageal varies and is being treated with a Sengstaken-Blakemore tube. Which of the following actions should the nurse perform?

A: Maintain constant observation while the balloons are inflated. R: A Sengstaken-Blakemore tube is used to stop or slow bleeding from the esophagus and stomach. When the balloons are inflated, they put pressure on the areas that are hemorrhaging to tamponade the bleeding. While the balloons are inflated, the client must be observed constantly because displacement can cause airway obstruction.

A nurse is teaching with a client about taking high doses of oral glucocorticoids for an extended period of time to treat RA. Which of the following instructions should the nurse include in the teaching?

A: Monitor for compression fractures of the back and neck R: High-dose, long-term use of glucocorticoids can result in bone loss in the back and neck within weeks of starting the medication. Clients experience an increase in parathyroid hormone, which causes calcium to move out of the bones can result in fractures.

A nurse is providing teaching to a client who has RA and reports persistent pain. Which of the following responses should the nurse make?

A: Ask a friend or family member to help with household chores. R: The nurse should instruct the client to allow others to assist with household chores to reduce the risk for joint injury and to give the client the opportunity to rest.

A nurse is teaching a client who has a new prescription for alendronate for the treatment of osteoporosis. Which of the following statements by the client indicates understanding of the teaching?

A: I will sit upright after taking the medication R: A client taking alendronate should sit upright for 30 min after administration to prevent esophageal irritation and ulceration. Therefore, the nurse should identify this statement as indicating an understanding of the teaching.

A nurse is assessing a client who has an obstruction of the common bile duct resulting from chronic cholecystitis. Which of the following findings should the nurse expect?

A: Fatty stools R: Chronic cholecystitis occurs following several bouts of acute cholecystitis. The repeated episodes of inflammation result in a fibrotic and contracted gallbladder. Because of inflammation in the gallbladder, bile needed to absorb fat and fat-soluble vitamins is unable to enter the bowel, resulting in steatorrhea (fatty stools).

A nurse is teaching a client who has cholecystitis about required dietary modifications. The nurse should include which of the following foods as appropriate for the client's diet?

A: Roast turkey R: Roast turkey is a low-fat protein that is an appropriate choice for inclusion in the client's diet. Low-fat food decreases stimulation of the gallbladder, thereby reducing associated symptoms.

A nurse is caring for a client who has just returned from the PACU after traditional cholecystectomy. In which of the following positions should the nurse place the client?

A: Semi-Fowler's R: The nurse should expect a prescription to place the client in semi-Fowler's position following a traditional cholecystectomy to facilitate lung expansion as well as coughing and deep breathing. This position will place minimal stress on the abdomen and increase comfort.

A nurse in a clinic is talking with a client who has a new diagnosis of OA. The nurse should anticipate that the client will require teaching about with of the following medications?

A: Acetaminophen R: According to the American Pain Society, acetaminophen is the primary drug of choice for treating osteoarthritis. The provider would likely begin with this medication.

A nurse is caring for a client who has RA and tells the nurse that she wears a copper bracelet to help her feel better. Which of the following responses should the nurse take?

A: "Yes, I understand that you feel better wearing your bracelet" R: The nurse illustrates the therapeutic communication technique of accepting. The nurse demonstrates the knowledge that the bracelet is harmless for the client and shows respect for the client's beliefs.

A nurse is teaching a parent of a child who has hemophilia how to control a minor bleeding episode. Which of the following statements by the parent indicates a need for further teaching?

A: "I will apply heat" R: Supportive measures to control a minor bleeding episode include applying cool compresses.

A nurse is caring for a client who is taking naproxen following an exacerbation of RA. Which of the following statements by the client requires further discussion by the nurse?

A: "I've been taking antacids to help with indigestion" R: NSAIDs, like naproxen, can cause serious adverse gastrointestinal reactions such as ulceration, bleeding, and perforation. Warning manifestations such as nausea or vomiting, gastrointestinal burning, and blood in the stool reported by the client require further investigation by the nurse. The client might be taking an antacid because he is experiencing one or more of these manifestations.

A nurse in the ED is preparing to d/c a client following a Grade II (moderate) ankle sprain. Which of the following instructions should the nurse plan to give the client?

A: Apply cold compress to the extremity intermittently R: Cold minimizes swelling and erythema to the affected area. Therefore, the nurse should instruct the client to apply cold compresses for no more than 20 min at a time.

A nurse is caring for a female client who has RA and asks the nurse if it is safe for her to take aspirin. The nurse should recognize which of the following findings in the clients history is a contraindication to this medication?

A: History of gastric ulcers R: Aspirin is contraindicated for clients who have a history of gastrointestinal bleeding and peptic ulcer disease because it impedes platelet aggregation. An adverse effect of aspirin is gastric bleeding.

A nurse is teaching a client who has OA. Which of the following instructions should the nurse include in the teaching?

A: Take acetaminophen as the primary medication to treat the pain. R: The nurse should instruct the client to take acetaminophen to treat osteoarthritis.

A nurse is caring for a client who is 3 days post-op following a right total hip arthroplasty. While transferring to a chair, the client cries out in pain. The nurse should assess the client for which of the following manifestations of dislocation of the hip prosthesis?

A: Shortening of the right leg R: The nurse should monitor the client for shortening of the affected leg as an indication of dislocation of the prosthesis. Other findings include increased hip pain, inability to move the extremity, and rotation of the hip internally or externally.

A young adult client with a new diagnosis of RA states, " The pain in my joints is just temporary thing. If I keep eating right and exercising, it'll go away." The nurse should identify the client is exhibiting which of the following defense mechanisms?

A: Denial R: By refusing to acknowledge or accept that she has a chronic disorder, the client is using the defense mechanism of denial.

A nurse is providing teaching to a client who has RA and a new prescription for methotrexate. Which of the following information should the nurse provide?

A: Drink 2 to 3 L of water per day while on this medication R: Methotrexate can cause renal toxicity. Adequate hydration promotes its excretion and helps prevent this adverse effect.

A nurse is teaching a group of clients about OA. Which of the following recommendations should the nurse include in the teaching?

A: Maintain a recommended body weight. R: Obesity is a risk factor for the development of osteoarthritis. Maintenance of an ideal weight is one way a client can prevent added wear and tear on joints and promote overall joint health.

A nurse is assessing a client who is 24hr post-op following an above-the-elbow amputation. Which of the following findings should the nurse identify as the priority?

A: Reports of muscle spasms R: The nurse should consider Maslow's hierarchy of needs, which includes five levels of priority. The first level consists of physiological needs; the second level consists of safety and security needs; the third level consists of love and belonging needs; the fourth level consists of personal achievement and self-esteem needs; and the fifth level consists of achieving full potential and the ability to problem solve and cope with life situations. When applying Maslow's hierarchy of needs priority-setting framework, the nurse should review physiological needs first. The nurse should then address the client's needs by following the remaining four hierarchal levels. It is important, however, for the nurse to consider all contributing client factors, as higher levels of the pyramid can compete with those at the lower levels, depending on the specific client situation. The fourth level of Maslow's hierarchy of needs includes usefulness, self-worth, and self-confidence in fulfilling self-esteem needs. Therefore, the nurse should identify the report of muscle spasms, a physiological need, as the priority client finding.

A nurse is caring for a client who had a below-the-knee amputation for gangrene of the right foot. The client reports sensations of burins and crushing pain in the toes of the right foot. Which of the following statements should the nurse make?

A: this type of pain usually decreases over time as the limb becomes less sensitive R: The nurse should recognize that the client is reporting phantom limb pain, a frequent complication following amputation. The nurse should instruct the client that the sensation should decrease over time. The nurse should recognize the pain, provide treatment, and handle the limb gently to decrease the risk of triggering pain.

A nurse is teaching a client who has RA about increasing physical rest as part of her treatment plan. Which of the following outcomes of this intervention should the nurse document as a goal for this client?

A: Reduced joint stress R: Rheumatoid arthritis in an autoimmune disease in which the cartilage and bone of the joints are destroyed resulting in increased pain and limited range of motion. The nurse should instruct the client that rest reduces stress on the joints and can be an effective intervention for relieving pain associated with rheumatoid arthritis.

A nurse is providing d/c instructions to a client who has RA and a prescription for oral betamethasone. Which of the following statements should the nurse make about how to take this medication?

A: Take this med with milk R: Betamethasone should be administered with milk or food to prevent gastric irritation.