MedSurg Test 2

A patient with rheumatoid arthritis comes to the clinic complaining of pain in the joint of his right great toe and is eventually diagnosed with gout. When planning teaching for this patient, what management technique should the nurse emphasize? A) Take OTC calcium supplements consistently. B) Restrict consumption of foods high in purines. C) Ensure fluid intake of at least 4 liters per day. D) Restrict weight-bearing on right foot.

B) Restrict consumption of foods high in purines.

A nurse is assessing a patient for risk factors known to contribute to osteoarthritis. What assessment finding would the nurse interpret as a risk factor? A) The patient has a 30 pack-year smoking history. B) The patients body mass index is 34 (obese). C) The patient has primary hypertension. D) The patient is 58 years old.

B) The patients body mass index is 34 (obese).

The nurse is completing a health history with a client in a clinic. What assessment finding best correlates with a diagnosis of osteoarthritis? A) joint stiffness that increases with activity B) erythema and edema over the affected joint C) anorexia and weight loss D) fever and malaise

A) joint stiffness that increases with activity

A variety of complications can occur after a leg amputation. Which is not a possibility in the immediate postoperative period? A) osteomyelitis B) hematoma C) hemorrhage D) infection

A) osteomyelitis

The nurse is performing a health history with a new client in the clinic. What is the most common reason for a client to seek medical attention for arthritis? A) pain B) joint swelling C) stiffness D) weakness

A) pain

The nurse is providing care for a patient who has had a below-the-knee amputation. The nurse enters the patients room and finds him resting in bed with his residual limb supported on pillow. What is the nurses most appropriate action? A) Inform the surgeon of this finding. B) Explain the risks of flexion contracture to the patient. C) Transfer the patient to a sitting position. D) Encourage the patient to perform active ROM exercises with the residual limb.

B) Explain the risks of flexion contracture to the patient.

A nurse is providing care for a patient who has just been diagnosed as being in the early stage of rheumatoid arthritis. The nurse should anticipate the administration of which of the following? A) Hydromorphone (Dilaudid) B) Methotrexate (Rheumatrex) C) Allopurinol (Zyloprim) D) Prednisone

B) Methotrexate (Rheumatrex)

A patient with possible bacterial meningitis is admitted to the ICU. What assessment finding would the nurse expect for a patient with this diagnosis? A) Pain upon ankle dorsiflexion of the foot B) Neck flexion produces flexion of knees and hips C) Inability to stand with eyes closed and arms extended without swaying D) Numbness and tingling in the lower extremities

B) Neck flexion produces flexion of knees and hips

The nurse teaches the client which intervention to avoid hip dislocation after replacement surgery? A) Keep the knees together at all times B) Never cross the affected leg when seated C) Avoid placing a pillow between the legs when sleeping D) Bend forward only when seated in a chair

B) Never cross the affected leg when seated

The nurse assesses a client after total right hip arthroplasty and observes a shortening of the extremity. The client reports severe pain in the right side of the groin. What is the priority action of the nurse? A) Apply Buck's traction. B) Notify the health care provider. C) Externally rotate the extremity. D) Bend the knee and rotate the knee internally.

B) Notify the health care provider.

A male patient presents to the clinic complaining of a headache. The nurse notes that the patient is guarding his neck and tells the nurse that he has stiffness in the neck area. The nurse suspects the patient may have meningitis. What is another well-recognized sign of this infection? A) Negative Brudzinskis sign B) Positive Kernigs sign C) Hyperpatellar reflex D) Sluggish pupil reaction

B) Positive Kernigs sign

While assessing a patient who has had knee replacement surgery, the nurse notes that the patient has developed a hematoma at the surgical site. The affected leg has a decreased pedal pulse. What would be the priority nursing diagnosis for this patient? A) Risk for Infection B) Risk for Peripheral Neurovascular Dysfunction C) Unilateral Neglect D) Disturbed Kinesthetic Sensory Perception

B) Risk for Peripheral Neurovascular Dysfunction

An older adult with rheumatoid arthritis says exercise was not effective. Which response will the nurse make to learn the reason for the failure of this treatment approach? A) "Does exercise usually work for you?" B) "Why do you think the exercise didn't work?" C) "Do you think you are too old to exercise?" D) "What types of exercise were you doing?"

D) "What types of exercise were you doing?"

As part of the assessment process for a client suspected of having gout, the nurse evaluated the client's serum uric acid levels. Select the value that is considered above the saturation point for crystal formation. A) 3.2 mg/dL (0.19mmol/L) B) 4.0 mg/dL (0.24 mmol/L) C) 5.4 mg/dL (0.32 mmol/L) D) 6.8 mg/dL (0.40 mmol/L)

D) 6.8 mg/dL (0.40 mmol/L)

The nurse is assessing a newly admitted client with a diagnosis of meningitis. On assessment, the nurse expects to find which of the following? A) Positive Kernig's sign B) Negative Brudzinski's sign C) Positive Romberg sign D) Hyper-alertness

A) Positive Kernig's sign

A patients decreased mobility is ultimately the result of an autoimmune reaction originating in the synovial tissue, which caused the formation of pannus. This patient has been diagnosed with what health problem? A) Rheumatoid arthritis (RA) B) Systemic lupus erythematosus C) Osteoporosis D) Polymyositis

A) Rheumatoid arthritis (RA)

The nurse is caring for a client who lives alone and had a total knee replacement. An appropriate nursing diagnosis for the client is: A) Risk for ineffective therapeutic regimen management B) Disturbed body image C) Situational low self-esteem D) Risk for avascular necrosis of the joint

A) Risk for ineffective therapeutic regimen management

A clinic nurse is caring for a patient with suspected gout. While explaining the pathophysiology of gout to the patient, the nurse should describe which of the following? A) Autoimmune processes in the joints B) Chronic metabolic acidosis C) Increased uric acid levels D) Unstable serum calcium levels

C) Increased uric acid levels

A client asks the nurse how to identify rheumatoid nodules with rheumatoid arthritis. What characteristic will the nurse include? A) tender to the touch B) reddened C) nonmovable D) located over bony prominence

D) located over bony prominence

A client with rheumatoid arthritis comes to the clinic for a second dose of etanercept. The dose prescribed is 25 mg subcutaneously. The medication is available in 50 mg per milliliter. How many milliliters will the nurse administer to the client? Record your answer using one decimal place.

0.5

Azathioprine (Imuran) has been prescribed for the client with severe rheumatoid arthritis. The dose prescribed is 2 mg/kg/day orally in two divided doses. The medication available is a 50-mg scored tablet. The client weighs 110 pounds. How many milligrams will the nurse prepare per dose for the client?

50

Which joint is most commonly affected in gout? A) Metatarsophalangeal B) Tarsal area C) Ankle D) Knee

A) Metatarsophalangeal

A neurologic deficit is best defined as a deficit of the: A) central and peripheral nervous systems with decreased, impaired, or absent functioning. B) central nervous system that affects one body system. C) central nervous system with absent functioning. D) peripheral nervous system with decreased or impaired functioning.

A) central and peripheral nervous systems with decreased, impaired, or absent functioning.

The nurse is caring for a client with a new onset of gout. What medication does the nurse anticipate will be ordered by the health care provider? A) colchicine B) probenecid C) anturane D) allopurinol

A) colchicine

The client asks the nurse about types of exercise that do not stress the joints. What exercise will the nurse include in the teaching plan? A) jogging B) running on a treadmill C) t'ai chi D) weight lifting

C) t'ai chi

A nurse is caring for an older adult patient who is preparing for discharge following recovery from a total hip replacement. Which of the following outcomes must be met prior to discharge? A) Patient is able to perform ADLs independently. B) Patient is able to perform transfers safely. C) Patient is able to weight-bear equally on both legs. D) Patient is able to demonstrate full ROM of the affected hip.

B) Patient is able to perform transfers safely.

A nurse is assessing a newly admitted client with meningitis. Which of the following findings in this client is most likely? A) Negative Kernig's sign B) Positive Brudzinski's sign C) Increased intake D) Hyper-alertness

B) Positive Brudzinski's sign

A client undergoes a total hip replacement. Which statement made by the client indicates to the nurse that the client requires further teaching? A)"I'll need to keep several pillows between my legs at night." B) "I need to remember not to cross my legs. It's such a habit." C) "The occupational therapist is showing me how to use a sock puller to help me get dressed." D) "I don't know if I'll be able to get off that low toilet seat at home by myself."

D) "I don't know if I'll be able to get off that low toilet seat at home by myself."

A patients rheumatoid arthritis (RA) has failed to respond appreciably to first-line treatments and the primary care provider has added prednisone to the patients drug regimen. What principle will guide this aspect of the patients treatment? A) The patient will need daily blood testing for the duration of treatment. B) The patient must stop all other drugs 72 hours before starting prednisone. C) The drug should be used at the highest dose the patient can tolerate. D) The drug should be used for as short a time as possible.

D) The drug should be used for as short a time as possible.

Which term indicates an accumulation of crystalline depositions in articular surfaces, bones, soft tissue, and cartilage? A) Subchondral bone B) Pannus C) Joint effusion D) Tophi

D) Tophi

Which of the following refers to fixation of a joint? A) Ankylosis B) Synovitis C) Pannus D) Articulations

A) Ankylosis

The nurse is caring for a client with palindromic rheumatism. The nurse knows that this type of rheumatism can lead to which diagnosis? A) Scleroderma B) Fibromyalgia C) Rheumatoid arthritis D) Systemic lupus erythematosus

C) Rheumatoid arthritis

An older adult patient had a hip replacement. When should the patient begin with assisted ambulation with a walker? A) 24 hours B) 72 hours C) 1 week D) 2 to 3 weeks

A) 24 hours

A nurse is working with a patient with rheumatic disease who is being treated with salicylate therapy. What statement would indicate that the patient is experiencing adverse effects of this drug? A) I have this ringing in my ears that just wont go away. B) I feel so foggy in the mornings and it takes me so long to wake up. C) When I eat a meal thats high in fat, I get really nauseous. D) I seem to have lost my appetite, which is unusual for me.

A) I have this ringing in my ears that just wont go away.

A nurse is performing the health history and physical assessment of a patient who has a diagnosis of rheumatoid arthritis (RA). What assessment finding is most consistent with the clinical presentation of RA? A) Cool joints with decreased range of motion B) Signs of systemic infection C) Joint stiffness, especially in the morning D) Visible atrophy of the knee and shoulder joints

C) Joint stiffness, especially in the morning

A client has been brought to the ED with altered LOC, high fever, and a purpura rash on the lower extremities. The family states the client was reporting neck stiffness earlier in the day. What action should the nurse do first? A) Initiate isolation precautions. B) Ensure the family receives prophylaxis antibiotic treatment. C) Administer prescribed antibiotics. D) Apply a cooling blanket.

A) Initiate isolation precautions.

A client with arterial insufficiency undergoes below-knee amputation of the right leg. Which action should the nurse include in the postoperative care plan? A) Elevating the stump for the first 24 hours B) Maintaining the client on complete bed rest C) Applying heat to the stump as the client desires D) Removing the pressure dressing after the first 8 hours

A) Elevating the stump for the first 24 hours

A patient is undergoing diagnostic testing to determine the etiology of recent joint pain. The patient asks the nurse about the difference between osteoarthritis (OA) and rheumatoid arthritis (RA). What is the best response by the nurse? A) OA is a considered a noninflammatory joint disease. RA is characterized by inflamed, swollen joints. B) OA and RA are very similar. OA affects the smaller joints such as the fingers, and RA affects the larger, weight-bearing joints like the knees. C) OA originates with an infection. RA is a result of your bodys cells attacking one another. D) OA is associated with impaired immune function; RA is a consequence of physical damage.

A) OA is a considered a noninflammatory joint disease. RA is characterized by inflamed, swollen joints.

A client is diagnosed with meningococcal meningitis. The 22-year-old client shares an apartment with one other person. What would the nurse expect as appropriate care for the client's roommate? A) Treatment with antimicrobial prophylaxis as soon as possible B) Admission to the nearest hospital for observation C) No treatment unless the roommate begins to show symptoms D) Bedrest at home for 72 hours

A) Treatment with antimicrobial prophylaxis as soon as possible

The nurse is developing a plan of care for a patient with Guillain-Barr syndrome. Which of the following interventions should the nurse prioritize for this patient? A) Using the incentive spirometer as prescribed B) Maintaining the patient on bed rest C) Providing aids to compensate for loss of vision D) Assessing frequently for loss of cognitive function

A) Using the incentive spirometer as prescribed

Which instruction should the nurse include when teaching the client following hip replacement surgery? (Select all that apply.) A) "You may cross your legs at the ankles only." B) "Place pillows between your legs when you lay on your side." C) "Avoid bending forward when sitting in a chair." D) "Use a raised toilet seat and high-seated chair." E) "It is okay to briefly flex the hip to put on your clothes."

B) "Place pillows between your legs when you lay on your side." C) "Avoid bending forward when sitting in a chair." D) "Use a raised toilet seat and high-seated chair."

A client diagnosed with arthritis doesn't want to take medications. Physical therapy and occupational therapy have been consulted for nonpharmacologic measures to control pain. What might physical and occupational therapy include in the care plan to help control this client's pain? A) Acupuncture B) An exercise routine that includes range-of-motion (ROM) exercises C) Heat therapy and nonsteroidal anti-inflammatory medications (NSAIDs) D) Cold therapy

B) An exercise routine that includes range-of-motion (ROM) exercises

After undergoing surgery the previous day for a total knee replacement, a client states, "I am not ready to ambulate yet." What should the nurse do? A) Tell the client that this noncompliance will be reported to the health care provider. B) Discuss the complications that the client may experience if there is lack of cooperation with the care plan. C) Do nothing because the client has the ultimate right to determine the degree of participation. D) Document the client's refusal to ambulate.

B) Discuss the complications that the client may experience if there is lack of cooperation with the care plan.

A patient has a diagnosis of rheumatoid arthritis and the primary care provider has now prescribed cyclophosphamide (Cytoxan). The nurses subsequent assessments should address what potential adverse effect? A) Infection B) Acute confusion C) Sedation D) Malignant hyperthermia

A) Infection

Which points should be included in the medication teaching plan for a client taking adalimumab? A) The medication is administered intramuscularly. B) The client should continue taking the medication if fever occurs. C) The medication is given at room temperature. D) It is important to monitor for injection site reactions.

D) It is important to monitor for injection site reactions.

The nurse caring for a patient in ICU diagnosed with Guillain-Barr syndrome should prioritize monitoring for what potential complication? A) Impaired skin integrity B) Cognitive deficits C) Hemorrhage D) Autonomic dysfunction

D) Autonomic dysfunction

A client with a history of gout experiences an attack every 2 to 3 months despite losing weight and stopping all alcohol intake. Which question will the nurse ask when assessing this client? A) "Are you taking the medication as prescribed?" B) "Have you reduced the amount of daily exercise?" C) "Have you increased your intake of fat-soluble vitamins?" D) "Are you taking frequent rest periods throughout the day?"

A) "Are you taking the medication as prescribed?"

Following a total knee replacement, the surgeon orders a continuous passive motion (CPM) device. The client asks about the purpose of this treatment. What is the best response by the nurse? A) "CPM increases range of motion of the joint." B) "CPM strengthens the muscles of the leg." C) "CPM delivers analgesic agents directly into the joint." D) "CPM prevents injury by limiting flexion of the knee."

A) "CPM increases range of motion of the joint."

A nurse is caring for a patient who had a right below-the-knee amputation (BKA). The nurse recognizes the importance of implementing measures that focus on preventing flexion contracture of the hip and maintaining proper positioning. Which of the following measures will best achieve these goals? A) Encouraging the patient to turn from side to side and to assume a prone position B) Initiating ROM exercises of the hip and knee 10 to 12 weeks after the amputation C) Minimizing movement of the flexor muscles of the hip D) Encouraging the patient to sit in a chair for at least 8 hours a day

A) Encouraging the patient to turn from side to side and to assume a prone position

The nurse is assessing a client with meningitis. Which of the following signs would the nurse expect to observe? A) Headache and nuchal rigidity B) Ptosis and diplopia C) Hyporeflexia in the lower extremities D) Numbness and vomiting

A) Headache and nuchal rigidity

Which intervention should the nurse implement with the client who has undergone a hip replacement? A) Instruct the client to avoid internal rotation of the leg. B) Place the client in high Fowler's position for meals. C) Have the client bend forward to rise from the chair. D) Adduct the legs by placing a pillow between the legs.

A) Instruct the client to avoid internal rotation of the leg.

A nurse is caring for a patient who is postoperative day 1 right hip replacement. How should the nurse position the patient? A) Keep the patients hips in abduction at all times. B) Keep hips flexed at no less than 90 degrees. C) Elevate the head of the bed to high Fowlers. D) Seat the patient in a low chair as soon as possible.

A) Keep the patients hips in abduction at all times.

A patient was brought to the emergency department after a fall. The patient is taken to the operating room to receive a right hip prosthesis. In the immediate postoperative period, what health education should the nurse emphasize? A) Make sure you dont bring your knees close together. B) Try to lie as still as possible for the first few days. C) Try to avoid bending your knees until next week. D) Keep your legs higher than your chest whenever you can.

A) Make sure you dont bring your knees close together.

The nurse is discussing the new medication that a client will be taking for treatment of rheumatoid arthritis. Which disease-modifying antirheumatic drug (DMARD) will the nurse educate the client about? A) Methotrexate B) Celecoxib C) Methylprednisolone D) Mercaptopurine azathioprine

A) Methotrexate

A patient diagnosed with meningitis would be expected to exhibit which of the following clinical manifestations? Select all that apply. A) Nuchal rigidity B) Positive Kernig's sign C) Positive Brudzinski's sign D) Photophobia E) Hypothermia

A) Nuchal rigidity B) Positive Kernig's sign C) Positive Brudzinski's sign D) Photophobia

A patient who has undergone a lower limb amputation is preparing to be discharged home. What outcome is necessary prior to discharge? A) Patient can demonstrate safe use of assistive devices. B) Patient has a healed, nontender, nonadherent scar. C) Patient can perform activities of daily living independently. D) Patientis free of pain.

A) Patient can demonstrate safe use of assistive devices.

Guillain-Barré syndrome is an autoimmune attack on the peripheral myelin sheath. Which of the following is an action of myelin? A) Speeds nerve impulse transmission B) Carries message to the next nerve cell C) Represents building block of nervous system D) Acts as chemical messenger

A) Speeds nerve impulse transmission

A nurse is caring for a 78-year-old patient with a history of osteoarthritis (OA). When planning the patients care, what goal should the nurse include? A) The patient will express satisfaction with her ability to perform ADLs. B) The patient will recover from OA within 6 months. C) The patient will adhere to the prescribed plan of care. D) The patient will deny signs or symptoms of OA.

A) The patient will express satisfaction with her ability to perform ADLs.

A rehabilitation nurse is working with a patient who has had a below-the-knee amputation. The nurse knows the importance of the patients active participation in self-care. In order to determine the patients ability to be an active participant in self-care, the nurse should prioritize assessment of what variable? A) The patients attitude B) The patients learning style C) The patients nutritional status D) The patients presurgical level of function

A) The patients attitude

A patient with rheumatic disease is complaining of stomatitis. The nurse caring for the patient should further assess the patient for the adverse effects of what medications? A) Corticosteroids B) Gold-containing compounds C) Antimalarials D) Salicylate therapy

B) Gold-containing compounds

A client with rheumatoid arthritis arrives at the clinic for a checkup. Which statement by the client refers to the most overt clinical manifestation of rheumatoid arthritis? A) "My legs feel weak." B) "My finger joints are oddly shaped." C) "I have pain in my hands." D) "I have trouble with my balance."

B) "My finger joints are oddly shaped."

A client is experiencing an acute exacerbation of rheumatoid arthritis. What should the nursing priority be? A) Providing comprehensive client teaching; including symptoms of the disorder, treatment options, and expected outcomes B) Administering ordered analgesics and monitoring their effects C) Performing meticulous skin care D) Supplying adaptive devices, such as a zipper-pull, easy-to-open beverage cartons, lightweight cups, and unpackaged silverware

B) Administering ordered analgesics and monitoring their effects

A patient with a total hip replacement is progressing well and expects to be discharged tomorrow. On returning to bed after ambulating, he complains of a new onset of pain at the surgical site. What is the nurses best action? A) Administer pain medication as ordered. B) Assess the surgical site and the affected extremity. C) Reassure the patient that pain is a direct result of increased activity. D) Assess the patient for signs and symptoms of systemic infection.

B) Assess the surgical site and the affected extremity.

A nurse is reviewing a patients activities of daily living prior to discharge from total hip replacement. The nurse should identify what activity as posing a potential risk for hip dislocation? A) Straining during a bowel movement B) Bending down to put on socks C) Lifting items above shoulder level D) Transferring from a sitting to standing position

B) Bending down to put on socks

A patient has recently been admitted to the orthopedic unit following total hip arthroplasty. The patient has a closed suction device in place and the nurse has determined that there were 320 mL of output in the first 24 hours. How should the nurse best respond to this assessment finding? A) Inform the primary care provider promptly. B) Document this as an expected assessment finding. C) Limit the patients fluid intake to 2 liters for the next 24 hours. D) Administer a loop diuretic as ordered.

B) Document this as an expected assessment finding.

Which is an appropriate nursing intervention in the care of the client with osteoarthritis? A) Provide an analgesic after exercise B) Encourage weight loss and an increase in aerobic activity C) Assess for gastrointestinal complications associated with COX-2 inhibitors D) Avoid the use of topical analgesics

B) Encourage weight loss and an increase in aerobic activity

A 69-year-old patient is brought to the ED by ambulance because a family member found him lying on the floor disoriented and lethargic. The physician suspects bacterial meningitis and admits the patient to the ICU. The nurse knows that risk factors for an unfavorable outcome include what? Select all that apply. A) Blood pressure greater than 140/90 mm Hg B) Heart rate greater than 120 bpm C) Older age D) Low Glasgow Coma Scale E) Lack of previous immunizations

B) Heart rate greater than 120 bpm C) Older age D) Low Glasgow Coma Scale

A patient is hospitalized with a severe case of gout. The patient has gross swelling of the large toe and rates pain a 10 out of 10. With a diagnosis of gout, what should the laboratory results reveal? A) Glucosuria B) Hyperuricemia C) Hyperproteinuria D) Ketonuria

B) Hyperuricemia

A patient is being prepared for a total hip arthroplasty, and the nurse is providing relevant education. The patient is concerned about being on bed rest for several days after the surgery. The nurse should explain what expectation for activity following hip replacement? A) Actually, patients are only on bed rest for 2 to 3 days before they begin walking with assistance. B) The physical therapist will likely help you get up using a walker the day after your surgery. C) Our goal will actually be to have you walking normally within 5 days of your surgery. D) For the first two weeks after the surgery, you can use a wheelchair to meet your mobility needs.

B) The physical therapist will likely help you get up using a walker the day after your surgery.

A nurse is planning patient education for a patient being discharged home with a diagnosis of rheumatoid arthritis. The patient has been prescribed antimalarials for treatment, so the nurse knows to teach the patient to self-monitor for what adverse effect? A) Tinnitus B) Visual changes C) Stomatitis D) Hirsutism

B) Visual changes

The nurse is teaching a client with osteoarthritis about the disease. What is the most important client focus for disease management? A) detection of systemic complications B) strategies for remaining active C) disease-modifying antirheumatic drug therapy D) prevention of joint deformity

B) strategies for remaining active

The parents of a client intubated due to the progression of Guillain-Barré syndrome ask whether their child will die. What is the best response by the nurse? A) "Don't worry; your child will be fine." B) "Once Guillain-Barré syndrome progresses to the diaphragm, survival decreases significantly." C) "There are no guarantees, but a large portion of people with Guillain-Barré syndrome survive." D) "It's too early to give a prognosis."

C) "There are no guarantees, but a large portion of people with Guillain-Barré syndrome survive."

A nurse is planning the care of a patient with osteomyelitis that resulted from a diabetic foot ulcer. The patient requires a transmetatarsal amputation. When planning the patients postoperative care, which of the following nursing diagnoses should the nurse most likely include in the plan of care? A) Ineffective Thermoregulation B) Risk-Prone Health Behavior C) Disturbed Body Image D) Deficient Diversion Activity

C) Disturbed Body Image

A clinic nurse is caring for a patient diagnosed with rheumatoid arthritis (RA). The patient tells the nurse that she has not been taking her medication because she usually cannot remove the childproof medication lids. How can the nurse best facilitate the patients adherence to her medication regimen? A) Encourage the patient to store the bottles with their tops removed. B) Have a trusted family member take over the management of the patients medication regimen. C) Encourage her to have her pharmacy replace the tops with alternatives that are easier to open. D) Have the patient approach her primary care provider to explore medication alternatives.

C) Encourage her to have her pharmacy replace the tops with alternatives that are easier to open.

The nurse is assessing a client with decreased dexterity of the hands related to rheumatoid arthritis. The nurse knows that which process causes joint deformities? A) Remission B) Exacerbation C) Inflammation D) Autoimmunity

C) Inflammation

A nurse is educating a patient with gout about lifestyle modifications that can help control the signs and symptoms of the disease. What recommendation should the nurse make? A) Ensuring adequate rest B) Limiting exposure to sunlight C) Limiting intake of alcohol D) Smoking cessation

C) Limiting intake of alcohol

A patient is scheduled for a total hip replacement and the surgeon has explained the risks of blood loss associated with orthopedic surgery. The risk of blood loss is the indication for which of the following actions? A) Use of a cardiopulmonary bypass machine B) Postoperative blood salvage C) Prophylactic blood transfusion D) Autologous blood donation

D) Autologous blood donation

A client with gout has been advised to lose weight. The client informs the nurse of plans to go on a "guaranteed rapid weight loss" plan that involves fasting and heavy exercise. Which response would be most appropriate? A) "The fasting is okay, but make sure you drink fluids when exercising." B) "Make sure to eat some fat occasionally with all that exercise." C) "Try combining the fasting with moderate exercise." D) "There might be some difficulties with your plan and fasting."

D) "There might be some difficulties with your plan and fasting."

A patient is suspected of having rheumatoid arthritis and her diagnostic regimen includes aspiration of synovial fluid from the knee for a definitive diagnosis. The nurse knows that which of the following procedures will be involved? A) Angiography B) Myelography C) Paracentesis D) Arthocentesis

D) Arthocentesis

Allopurinol (Zyloprim) has been ordered for a patient receiving treatment for gout. The nurse caring for this patient knows to assess the patient for bone marrow suppression, which may be manifested by which of the following diagnostic findings? A) Hyperuricemia B) Increased erythrocyte sedimentation rate C) Elevated serum creatinine D) Decreased platelets

D) Decreased platelets

A nurse is emptying an orthopedic surgery patients closed suction drainage at the end of a shift. The nurse notes that the volume is within expected parameters but that the drainage has a foul odor. What is the nurses best action? A) Aspirate a small amount of drainage for culturing. B) Advance the drain 1 to 1.5 cm. C) Irrigate the drain with normal saline. D) Inform the surgeon of this finding.

D) Inform the surgeon of this finding.

A client has a serum study that is positive for the rheumatoid factor. What will the nurse tell the client about the significance of this test result? A) It is diagnostic for Sjögren's syndrome. B) It is diagnostic for systemic lupus erythematosus. C) It is specific for rheumatoid arthritis. D) It is suggestive of rheumatoid arthritis.

D) It is suggestive of rheumatoid arthritis.

A nurse is caring for a client who recently underwent a total hip replacement. What is the best action by the nurse for client care? A) Ease the client onto a low toilet seat. B) Allow the client's legs to be crossed at the knees when out of bed. C) Use soft chairs when the client is sitting out of bed. D) Limit hip flexion of the client's hip when the client sits up.

D) Limit hip flexion of the client's hip when the client sits up.

A nurse is caring for a patient who is recovering in the hospital following orthopedic surgery. The nurse is performing frequent assessments for signs and symptoms of infection in the knowledge that the patient faces a high risk of what infectious complication? A) Cellulitis B) Septic arthritis C) Sepsis D) Osteomyelitis

D) Osteomyelitis

A community health nurse is performing a visit to the home of a patient who has a history of rheumatoid arthritis (RA). On what aspect of the patients health should the nurse focus most closely during the visit? A) The patients understanding of rheumatoid arthritis B) The patients risk for cardiopulmonary complications C) The patients social support system D) The patients functional status

D) The patients functional status

A client is hospitalized with Guillain-Barré syndrome. Which nursing assessment finding is most significant? A) Warm, dry skin B) Urine output of 40 ml/hour C) Soft, nondistended abdomen D) Uneven, labored respirations

D) Uneven, labored respirations

The nurse caring for a patient diagnosed with Guillain-Barr syndrome is planning care with regard to the clinical manifestations associated this syndrome. The nurse's communication with the patient should reflect the possibility of what sign or symptom of the disease? A) Intermittent hearing loss B) Tinnitus C) Tongue enlargement D) Vocal paralysis

D) Vocal paralysis

The nurse is gathering a health history for a client with osteoarthritis. What clinical manifestation will the nurse expect to find? A) small joint involvement B) joint pain that increases with rest C) subcutaneous nodules D) early morning stiffness

D) early morning stiffness

A client asks the nurse why his residual limb cannot be elevated on a pillow. What is the best response by the nurse? A) "Elevating the leg might lead to a flexion contracture." B) "You need to turn yourself side to side. If your leg is on a pillow, you would not be able to do that." C) "Elevating the extremity may increase your chances of compartment syndrome." D) "I am sorry. We ran out of pillows. I can elevate it on a few blankets."

A) "Elevating the leg might lead to a flexion contracture."

The nurse is taking health history from a client admitted to rule out Guillain-Barre syndrome. An important question to ask related to the diagnosis is which of the following? A) "Have you experienced any viral infections in the last month?" B) "Have you experienced any ptosis in the last few weeks?" C) "Have you had difficulty with urination in the last 6 weeks?" D) "Have you developed any new allergies in the last year?"

A) "Have you experienced any viral infections in the last month?"

A client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct? A) "OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints." B) "OA and RA are very similar. OA affects the smaller joints and RA affects the larger, weight-bearing joints." C) "OA affects joints on both sides of the body. RA is usually unilateral." D) "OA is more common in women. RA is more common in men."

A) "OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints."

A client with Guillain-Barré syndrome has paralysis affecting the respiratory muscles and requires mechanical ventilation. When the client asks the nurse about the paralysis, how should the nurse respond? A) "The paralysis caused by this disease is temporary." B) "You'll be permanently paralyzed; however, you won't have any sensory loss." C) "It must be hard to accept the permanency of your paralysis." D) "You'll first regain use of your legs and then your arms."

A) "The paralysis caused by this disease is temporary."

The surgical nurse is admitting a patient from postanesthetic recovery following the patients below-the-knee amputation. The nurse recognizes the patients high risk for postoperative hemorrhage and should keep which of the following at the bedside? A) A tourniquet B) A syringe preloaded with vitamin K C) A unit of packed red blood cells, placed on ice D) A dose of protamine sulfate

A) A tourniquet

A patient has returned to the postsurgical unit from the PACU after an above-the-knee amputation of the right leg. Results of the nurses initial postsurgical assessment were unremarkable but the patient has called out. The nurse enters the room and observes copious quantities of blood at the surgical site. What should be the nurses initial action? A) Apply a tourniquet B) Elevate the residual limb. C) Apply sterile gauze. D) Call the surgeon.

A) Apply a tourniquet

The nurse is caring for a client diagnosed with Guillain-Barre syndrome. His spouse asks about recovery rates. The nurse can correctly relate which of the following? A) Approximately 60% to 75% of clients recover completely. B) Only a very small percentage (5% to 8%) of clients recover completely. C) Usually 100% of clients recover completely. D) No one with Guillain-Barre syndrome recovers completely.

A) Approximately 60% to 75% of clients recover completely.

Which of the following procedures involves a surgical fusion of the joint? A) Arthrodesis B) Synovectomy C) Tenorrhaphy D) Osteotomy

A) Arthrodesis

What is the priority intervention for a client who has been admitted repeatedly with attacks of gout? A) Assess diet and activity at home B) Place client on bed rest C) Increase fluids D) Insert a Foley catheter

A) Assess diet and activity at home

A client is experiencing an acute attack of gout. Which medications will the nurse anticipate being prescribed for this client? Select all that apply. A) Colchicine B) Allopurinol C) Febuxostat D) Prednisone E) Ibuprofen

A) Colchicine D) Prednisone E) Ibuprofen

A client is reporting pain following orthopedic surgery. Which intervention will help relieve pain? A) Elevate the affected extremity and use cold applications. B) Breathe deeply and cough every 2 hours until ambulation is possible. C) Do ROM exercises as indicated. D) Apply antiembolism stockings as indicated.

A) Elevate the affected extremity and use cold applications.

The nurse is teaching a patient with Guillain-Barr syndrome about the disease. The patient asks how he can ever recover if demyelination of his nerves is occurring. What would be the nurses best response? A) Guillain-Barr spares the Schwann cell, which allows for remyelination in the recovery phase of the disease. B) In Guillain-Barr, Schwann cells replicate themselves before the disease destroys them, so remyelination is possible. C) I know you understand that nerve cells do not remyelinate, so the physician is the best one to answer your question. D) For some reason, in Guillain-Barr, Schwann cells become activated and take over the remyelination process.

A) Guillain-Barr spares the Schwann cell, which allows for remyelination in the recovery phase of the disease.

A nurse is planning the care of a patient who has undergone orthopedic surgery. What main goal should guide the nurses choice of interventions? A) Improving the patients level of function B) Helping the patient come to terms with limitations C) Administering medications safely D) Improving the patients adherence to treatment

A) Improving the patients level of function

What intervention is a priority for a client diagnosed with osteoarthritis? A) Physical therapy and exercise B) Hydrotherapy C) Colchicine D) Allopurinol

A) Physical therapy and exercise

The nurse is planning teaching for a client with gout. Which topics will the nurse include in the teaching? Select all that apply. A) Weight loss B) Limiting exercise C) Decreasing alcohol intake D) Avoiding purine-rich foods E) Restricting the intake of water

A) Weight loss C) Decreasing alcohol intake D) Avoiding purine-rich foods

A patient has been diagnosed with meningococcal meningitis at a community living home. When should prophylactic therapy begin for those who have had close contact with the patient? A) Within 24 hours after exposure B) Within 48 hours after exposure C) Within 72 hours after exposure D) Therapy is not necessary prophylactically and should only be used if the person develops symptoms.

A) Within 24 hours after exposure

The patient scheduled for a Syme amputation is concerned about the ability to eventually stand on the amputated extremity. How should the nurse best respond to the patients concern? A) You will eventually be able to withstand full weight-bearing after the amputation. B) You will have minimal weight-bearing on this extremity but youll be taught how to use an assistive device. C) You likely will not be able to use this extremity but you will receive teaching on use of a wheelchair. D) You will be fitted for a prosthesis which may or may not allow you to walk.

A) You will eventually be able to withstand full weight-bearing after the amputation.

A patient with rheumatoid arthritis comes into the clinic for a routine check-up. On assessment the nurse notes that the patient appears to have lost some of her ability to function since her last office visit. Which of the following is the most appropriate action? A) Arrange a family meeting in order to explore assisted living options. B) Refer the patient to a support group. C) Arrange for the patient to be assessed in her home environment. D) Refer the patient to social work.

C) Arrange for the patient to be assessed in her home environment.

A patient with Guillain-Barr syndrome has experienced a sharp decline in vital capacity. What is the nurses most appropriate action? A) Administer bronchodilators as ordered. B) Remind the patient of the importance of deep breathing and coughing exercises. C) Prepare to assist with intubation. D) Administer supplementary oxygen by nasal cannula.

C) Prepare to assist with intubation.

A nurse is caring for a client who underwent a total hip replacement. What should the nurse and other caregivers do to prevent dislocation of the new prosthesis? A) Keep the affected leg in a position of adduction. B) Use measures other than turning to prevent pressure ulcers. C) Prevent internal rotation of the affected leg. D) Keep the hip flexed by placing pillows under the client's knee.

C) Prevent internal rotation of the affected leg.

The nurse is caring for a patient who underwent a total hip replacement yesterday. What should the nurse do to prevent dislocation of the new prosthesis? A) Keep the affected leg in a position of adduction. B) Have the patient reposition himself independently. C) Protect the affected leg from internal rotation. D) Keep the hip flexed by placing pillows under the patients knee.

C) Protect the affected leg from internal rotation.

An elderly patients hip joint is immobilized prior to surgery to correct a femoral head fracture. What is the nurses priority assessment? A) The presence of leg shortening B) The patients complaints of pain C) Signs of neurovascular compromise D) The presence of internal or external rotation

C) Signs of neurovascular compromise

Six weeks after an above-the-knee amputation (AKA), a patient returns to the outpatient office for a routine postoperative checkup. During the nurses assessment, the patient reports symptoms of phantom pain. What should the nurse tell the patient to do to reduce the discomfort of the phantom pain? A) Apply intermittent hot compresses to the area of the amputation. B) Avoid activity until the pain subsides. C) Take opioid analgesics as ordered. D) Elevate the level of the amputation site.

C) Take opioid analgesics as ordered.

A client is taking ibuprofen for the treatment of osteoarthritis. What education will the nurse give the client about the medication? A) Take the medication on an empty stomach in order to increase effectiveness. B) Since the medication is able to be obtained over the counter, it has few side effects. C) Take the medication with food to avoid stomach upset. D) Inform the health care provider if there is ringing in the ears.

C) Take the medication with food to avoid stomach upset.

A client has severe osteoarthritis in the left hip and is having surgery to replace both articular surfaces of the hip. What type of surgical procedure will the nurse prepare the client for? A) Arthrodesis B) Hemiarthroplasty C) Total arthroplasty D) Osteotomy

C) Total arthroplasty

A 91-year-old patient is slated for orthopedic surgery and the nurse is integrated gerontologic considerations into the patients plan of care. What intervention is most justified in the care of this patient? A) Administration of prophylactic antibiotics B) Total parenteral nutrition (TPN) C) Use of a pressure-relieving mattress D) Use of a Foley catheter until discharge

C) Use of a pressure-relieving mattress

The nurse is discussing life management with the client with rheumatoid arthritis in a health clinic. What assessment finding indicates the client is having difficulty implementing self-care? A) ability to perform activities of daily living (ADL) B) decreased joint pain C) increased fatigue D) a weight gain of 2 pounds

C) increased fatigue

A nurse is assessing a patient with rheumatoid arthritis. The patient expresses his intent to pursue complementary and alternative therapies. What fact should underlie the nurses response to the patient? A) New evidence shows CAM to be as effective as medical treatment. B) CAM therapies negate many of the benefits of medications. C) CAM therapies typically do more harm than good. D) Evidence shows minimal benefits from most CAM therapies.

D) Evidence shows minimal benefits from most CAM therapies.

A nurse is caring for a patient who has had a total hip replacement. The nurse is reviewing health education prior to discharge. Which of the patient's statements would indicate to the nurse that the patient requires further teaching? A) I'll need to keep several pillows between my legs at night. B) I need to remember not to cross my legs. It's such a habit. C) The occupational therapist is showing me how to use a sock puller to help me get dressed. D) I will need my husband to assist me in getting off the low toilet seat at home.

D) I will need my husband to assist me in getting off the low toilet seat at home.

A nurses plan of care for a patient with rheumatoid arthritis includes several exercise-based interventions. Exercises for patients with rheumatoid disorders should have which of the following goals? A) Maximize range of motion while minimizing exertion B) Increase joint size and strength C) Limit energy output in order to preserve strength for healing D) Preserve and increase range of motion while limiting joint stress

D) Preserve and increase range of motion while limiting joint stress

patient who has had an amputation is being cared for by a multidisciplinary rehabilitation team. What is the primary goal of this multidisciplinary team? A) Maximize the efficiency of care B) Ensure that the patients health care is holistic C) Facilitate the patients adjustment to a new body image D) Promote the patients highest possible level of function

D) Promote the patients highest possible level of function

A client is recovering from an attack of gout. What will the nurse include in the client teaching? A) Weight loss will reduce purine levels. B) Weight loss will reduce inflammation. C) Weight loss will increase uric acid levels and reduce stress on joints. D) Weight loss will reduce uric acid levels and reduce stress on joints.

D) Weight loss will reduce uric acid levels and reduce stress on joints.