Chapter 20

A client presents with painful, inflamed fingers with small, hard, yellow nodules that have a sandy yellow drainage. Which medication does the nurse prepare to administer to the client?

Allopurinol (Zyloprim)

A client who has had total hip replacement surgery asks the nurse when she will be able to use a regular-height toilet seat again. What is the nurse's best response?

As soon as you are able to walk without a limp

The nurse is caring for a post operative client on the med surg unit following a total left hip replacement the previous day. During the assessment, the nurse notes that the client's left leg is cool, with weak pedal pulses. What is the nurse's first action?

Assess circulatory status of the right leg.

The nurse is caring for a client who had right total knee replacement surgery 3 days ago. During the assessment, the nurse notes that the client's right lower leg is twice the size of the left. What is the nurse's priority intervention?

Assess the client's respiratory status.

The nurse is caring for a client who has had hip replacement surgery 2 days before. The client reports severe pain at the surgical site despite having received 2 Vicodin tablets 2 hours previously. The client is requesting IV pain medication. What is the nurse's primary intervention?

Assess the surgical site for signs of infection

A client had a total knee replacement earlier in the day and has a continuous femoral nerve blockade. When entering the room to assess the client, the nurse notes that the television volume is quite loud. The client explains that it is hard to hear with "all the ringing in my ears." What action by the nurse takes priority?

Call another nurse to notify the anesthesiologist immediately.

A client is admitted for a total hip replacement. Past medical history includes diabetes mellitus type2, a heart attack 5 years ago, and allergies to sulfa drugs. The client currently takes insulin on a sliding scale and celecoxib (Celebrex). Before administering the client's medications, which action by the nurse is most appropriate?

Call the physician to clarify the order

The school nurse removes a tick embedded in a student's scalp by the hairline. Which follow-up instruction is the nurse sure to provide to the mother?

Call your pediatrician right away if a fever or a red rash develops at the bite.

The nurse has taught a client with lupus about skin protection in the clinic. Later, the nurse sees the client at an outdoor music festival. Which observation by the nurse indicates that the client requires further instruction?

Client is discussing her new perm.

The nurse is working a t a clinic, where several clients are waiting to be seen. Which client does the nurse assess first?

Client with temporal arteritis with new onset of blurry double vision

A nurse is caring for a client who has had rheumatoid arthritis for 5 years. Which laboratory value requires the most immediate intervention by the nurse?

Creatinine, 3.2 mg/dL

The nurse is working in a clinic when a young male client presents with reports of pain and urination. The client wants testing for sexually transmitted diseases. The nurse notes that the client's eyes are red and inflamed. What question by the nurse is most important?

Do you have any new joint pain

The nurse is working in a primary care clinic and sees a young male client. The client is athletic and is well over 6 feet tall, with size 14 shoes. What diagnostic test does the nurse facilitate for the client?

Echocardiography

(Select All) What interventions does the nurse recommend for a client who is to be discharged home following total hip replacement surgery?

Elevated toilet seat Walker TED hose

The nurse is caring for a client who has dysphagia caused by systemic sclerosis. What is the best intervention for the nurse to implement for this client?

Encourage frequent, high protein, easy to swallow foods.

The nurse is caring for a female client who has a history of chronic fatigue syndrome. Which finding is the nurse surprised to see in the client's record?

Hemoglobin, 7.2 g/dL

(Select All) The nurse is teaching a client with rheumatoid arthritis about joint protection principles. What information does the nurse include?

Hold objects with two hands, not one Use assistive adaptive devices Bend at your knees to lift objects

The nurse is caring for a pregnant client who is taking umbra (adalimumab) to control symptoms of rheumatoid arthritis. The client mentions the pain and inconvenience of the subcutaneous injections and asks, "While I'm pregnant, can I take this drug by mouth instead?" What is the nurse's best response?

Humira can be given only by subcutaneous injection.

The nurse provides discharge teaching for a client to prevent a new attack of gout. Which statement by the client indicates that additional teaching is required?

I hate to start limiting my fluid intake so much!

An older adult client is scheduled for knee replacement surgery. Which statement by the client indicates a need for further preoperative instruction?

I need to keep my leg positioned away from my body.

The nurse is teaching a community health class about health promotion techniques. Which statement by a student indicates a strategy to help prevent the development of osteoarthritis?

I will keep my BMI under 24

The nurse is teaching a client who has osteoarthritis ways to slow progression of the disease. Which statement indicates that the client understands the nurse's instruction?

I will start swimming twice a week.

The nurse is instructing a client about the management of systemic sclerosis. Which statement indicates that the client requires additional teaching?

Ice packs will help relieve the aching pain in my hips and knees.

The nurse is caring for an older adult client who will be discharged after being hospitalized for a total hip replacement. Which statement indicates that arrangements may have to be made to have the client's medications supervised at home?

If my legs get swollen, I will take an extra Coumadin pill that day.

The nurse is caring for an older adult client who will be discharged home to live with an adult daughter. The client will be given prescriptions for four new medications for rheumatoid arthritis. How does the nurse ensure that the client will be able to take the medications correctly at home?

Include the clint's daughter when teaching the client about the medications.

A client is reeiving warfarin (Coumadin) daily following toal hip replacement surgery. Which laboratory value requires intervention by the nurse?

International normalized ratio (INR), 5.1

A client returns to the medical-surgical unit after a total hip replacement with a large wedge-shaped pillow between his legs. The client's daughter asks the nurse why the pillow is in place. What is the nurse's best response?

It will keep the new hip from becoming dislocated

The nurse is caring for an older adult client who has fallen and fractured her hop. The client will have hip replacement surgery followed by extensive rehabilitation. The client confides in the nurse, "I feel like I don't have any control over anything anymore now that I am old." What is the nurse's best response?

It's important to control what you can right now, like making out your menu every day and working with the therapists.

(Select All) After hip replacement surgery, a client receives two doses of enoxaprain (Lovenox) during the day shift. What orders does the nurse anticipate for the client?

Laboratory draw for platelet count Order for protamine sulfate

The nurse is working with a client who has severe rheumatoid arthritis in their hands. The client states that she is frustrated at mealtime because it is difficult for her to manage cups and silverware. What is the nurse's best response?

Let's see if the occupational therapist can provide you with some utensils that are easier for you to use.

Which statement by a client indicates that additional teaching is needed in the management of fibromyalgia?

Limiting my physical activity will reduce my fatigue

A client is suspected to have rheumatoid arthritis. Which manifestations does the nurse assess this client carefully for?

Low-grade fever, fatigue, anorexia with weight loss

The nurse is teaching a client how to reduce the pain that she often experiences with fibromyalgia. Which statement does the nurse include in the teaching?

Make sure that you get enough sleep every night

The school nurse is working with a group of high school students who will be going on a field trip to a nature center. Which student is at highest risk for a tick bite?

Male student wearing a long-sleeved shirt and shorts.

A client with rheumatoid arthritis had abdominal surgery and has returned to the postoperative nursing unit. The client is unable to use the incentive spiromter correctly, demonstrating limited lung volume and fatiguing easily. What action by the nurse takes priority?

Notify the physician immediately

The home care nurse is making a follow-up visit to a client who had total hip replacement surgery 2 weeks ago. Which client statement indicates a need for clarification regarding postoperative routine?

Now tha my hip doesn't hurt, I can cross my legs like a lady again.

A client had a total knee replacement this morning and has a continuous passive motion machine. What activity related to the CPM does the RN delegate to the unlicensed assistive personnel?

Placing controls out of the reach of confused clients

A client with diagnosed osteoarthritis comes to the clinic reporting a low-grade fever, fatigue, and bilateral joint pain. What action by the nurse is most appropriate?

Prepare the client for a laboratory draw for rheumatoid factor

The nurse is instructing a client about management of discoid lupus erythematosus. Which statement indicates that the client requires additional teaching?

Steroids weaken the immune system, so I will wash my hands frequently.

A female client with rheumatoid arthritis has taken Rheumatrex (methotrexate) for the past year to control her symptoms. The client comes to the clinic and tells the nurse that a home pregnancy test was positive. What is the nurse's best response?

Stop taking Rheumatrex immediately. I'll tell the physician you are pregnant.

The nurse is caring for a client who is 1 day post total hip replacement. The nurse is instructing the client about how to perform quadriceps-setting exercises correctly. Which direction does the nurse provide to the client?

Straighten your legs and push the back of your knees into the mattress

The nurse is working with a client who will be taking 20 mg of prednisone daily for rheumatoid arthritis. Which precautions does the nurse give the client about taking this medication?

Take calcium and vitamin D supplements daily

The nurse is caring for an older adult client who has had a hip replacement 2 days previously. Which assessment finding is the best indicator that the client does not need pain medication at this time?

The client states that she has no pain

A client with a history of rheumatoid arthritis will be starting drug therapy with etanercept (Enbrel). What is most important for the nurse to teach the client

The correct technique for subcutaneous injections

A client who has had bilateral total knee replacements is prescribed enoxaprin sodium (Lovenox) injections twice daily for the next 3 weeks. The client asks the nurse why she has to have the medication. What is the nurse's best response?

To prevent the formation of blood clots in your legs.

A client with chronic gout take probenecid (Benemid) and comes to the clinic reporting frequent severe headaches and a new gout flare. The client is frustrated because the gout had been under good control Which question by the nurse is most helpful?

What do you take for your headaches?

The nurse is caring for a client who has a history of severe rheumatoid arthritis. The client becomes combative and abusive to the staff when she is unable to perform personal care independently. What is the best statement the nurse can make to the client at this time

You seem frustrated. Would you like to try to dress again in a few minutes?