Quiz 4 Musculoskeletal Review

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. Colchicine B. Naproxen C. Aspirin D. Prednisone

Correct Answer C. Aspirin Aspirin can decrease the effectiveness of probenecid. The nurse should caution the client to avoid interaction between probenecid and salicylate medications. Colchicine is an anti-inflammatory gout medication used in conjunction with probenecid in acute gout attacks. It is not known to interact with probenecid. Naproxen Naproxen is an NSAID medication used to decrease inflammation for clients who have gout and is not known to interact with probenecid. • Prednisone Prednisone is a glucocorticoid medication used to treat gout and is not known to interact with probenecid.:

A nurse is teaching a group of clients at a senior center about the risk factors for osteoporosis. Which of the following statements should the nurse include in the teaching? A. "Extended periods of immobility increase your risk of osteoporosis." B. "Prolonged periods of sun exposure increase your risk of osteoporosis." C. "Eating a diet high in protein can reduce your risk of osteoporosis." D. "Corticosteroid therapy will reduce your risk of osteoporosis.

Correct Answer: A. "Extended periods of immobility increase your risk of osteoporosis." Osteoporosis is a disorder of weakened bones due to a loss of bone mass and a change in bone structure. Immobility can result in osteoporosis; therefore, weight-bearing exercise, such as walking, can help prevent osteoporosis. Incorrect Answers: B. Prolonged exposure to sunlight does not increase the risk of developing osteoporosis. Appropriate amounts of sun exposure increase vitamin D levels, which increases the absorption of calcium. C. Eating large amounts of protein can result in more calcium loss through the kidneys. D. The chronic use of steroid medications increases the risk of osteoporosi

A nurse is teaching a client who has low back pain about heat therapy. Which of the following statements by the client indicates an understanding of the teaching? A. "I need to place a towel between the heating pad and my skin." B. "I'll need to turn up the temperature if I can't feel the heat." C. "I'll sleep on top of the heating pad to increase the heat penetration." D. "Keeping the heat continuously on my back will help it heal."

Correct Answer: A. "I need to place a towel between the heating pad and my skin." The nurse should instruct the client to place a towel between the heating pad and the skin to reduce the risk of burns. Incorrect Answers: B. The nurse should instruct the client not to increase the temperature because this can cause burns. C. The nurse should instruct the client not to sleep on top of the heating pad because this can result in burns. D. The nurse should instruct the client to apply heat for 30 minutes at a time to reduce the risk for burns.

A nurse is teaching a client who has osteoporosis about a new prescription for risedronate. Which of the following client statements indicates an understanding of the teaching? A. "I will take this medication with a full cup of water." B. "I will lie down after I take this medication." C. "I will take this medication with food." D. "I will take this medication at bedtime."

Correct Answer: A. "I will take this medication with a full cup of water." The nurse should instruct the client that risedronate should be taken with at least 180 to 240 mL (6 to 8 oz) of water. Incorrect Answers: B. The nurse should instruct the client to remain upright for at least 30 minutes after taking risedronate to minimize adverse gastrointestinal effects. C. The nurse should instruct the client to take risedronate on an empty stomach. Food greatly reduces the absorption of the medication. D. The nurse should instruct the client to take risedronate in the morning, at least 30 minutes before the first meal of the day.

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 burning 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 B. Try to look at the surgical wound as a reminder the limb is gone C. Use a cold compress intermittently to decrease these pain sensations D. Grief over the lost limb can sometimes cause denial that the limb is really gone

Correct Answer: A. "This type of pain usually decreases over time as the limb becomes less sensitive."----- 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 providing discharge instructions about calcium supplements to an older adult female client who has osteoporosis and recently underwent a repair of a fracture in her right hip. Which of the following instructions should the nurse include? A. "You should take your calcium supplement with a large glass of water." B. "You should increase your intake of grain cereals while taking calcium supplements." C. "You should take at least 2600 mg of calcium supplements daily." D. "You will not need to take vitamin D with your calcium supplement after menopause."

Correct Answer: A. "You should take your calcium supplement with a large glass of water." The nurse should instruct the client to take calcium supplements with a large glass of water with or after meals to promote absorption of the supplement. Incorrect Answers: B. Foods such as oatmeal and other grain cereals contain phytic acid, which can decrease the absorption of calcium supplements. C. The recommended dietary allowance (RDA) of calcium for an older adult female client is 1200 mg. Supplements are taken to make up the difference between what the diet provides and the RDA. There is a risk of calcium toxicity if calcium supplementation exceeds the RDA.

A nurse working in the emergency department is admitting a client who has a gastric ulcer and gastrointestinal (GI) bleeding. Which of the following factors in the client's medical history should the nurse report to the provider? A. Arthritis treated with ibuprofen every 8 hours as needed B. Previous tobacco smoking with cessation 5 years ago C. Negative H. pylori breath test 1 year prior D. Prescribed bismuth subsalicylate as needed for GI upset

Correct Answer: A. Arthritis treated with ibuprofen every 8 hours as needed The nurse should identify that ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). NSAIDs can cause gastrointestinal bleeding and are contraindicated for clients who have ulcer disease. NSAIDs inhibit prostaglandin secretion, which decreases blood flow in the GI tract and decreases bicarbonate and mucus secretion. This environment promotes the secretion of gastric acid and needs to be reported to the provider. Incorrect Answers: B. The nurse should identify that smoking can cause ulcers due to an increase in the amount of acid present in the GI tract. However, a client who smoked previously but stopped smoking 5 years ago does not have this current risk. Therefore, this factor does not need to be reported to the provider. C. The nurse should identify that up to 75% of all clients who have peptic ulcer disease have H. pylori bacteria in their GI tract. H. pylori is highly associated with duodenal ulcers and should be ruled out in patients who are suspected to have an ulcer. Therefore, this factor does not need to be reported to the client's provider. D The nurse should identity that bismuth subsalicylate is a medication used to treat GI upset and prevent

A nurse is talking with an older adult client who has an elevated risk for osteoporosis about strategies for preventing bone loss. Which of the following instructions should the nurse provide? A. Begin a program of brisk walking B. Take 800 mg of calcium per day C. Drink plenty of sparkling water D. Drink 8 oz of red wine each day

Correct Answer: A. Begin a program of brisk walking Weight-bearing exercises help maintain bone mass and prevent osteoporosis. Walking is generally a safe activity for older clients. Incorrect Answers: B. An adequate daily intake of calcium promotes bone strength and can help reduce the risk of osteoporosis. The recommended calcium intake for women 51 years of age or older is 1,200 mg/day. For men, the recommendation is 1,000 mg/day up to age 70 and 1,200 mg/day after that. C. Carbonated beverages can interfere with the absorption of calcium. D. Drinking alcohol excessively can cause bone loss. One alcoholic drink per day will unlikely cause significant bone loss but will not aid prevention.

A nurse is caring for a client who has a new diagnosis of rheumatoid arthritis. The nurse should anticipate a prescription from the provider for which of the following medications for daily management of this condition? A. Celecoxib B. Prednisone C. Adalimumab D. Abatacept

Correct Answer: A. Celecoxib The nurse should anticipate that the provider will prescribe celecoxib, which is a nonsteroidal anti-inflammatory drug (NSAID). This medication or another NSAID should be initiated for a client who has a new diagnosis of rheumatoid arthritis. Incorrect Answers: B. Prednisone is a glucocorticoid and is indicated for clients who have severe rheumatoid arthritis. It should be used for short-term treatment due to the adverse effects of the medication. C. Adalimumab is a monoclonal antibody that is used for clients with moderate to severe rheumatoid arthritis who have not responded well to other forms of treatment. D. Abatacept is a T-cell activation inhibitor and acts by reducing T-cells, interferon gamma, and interleukins. This medication is indicated for clients with rheumatoid arthritis who have not responded well to other forms of treatment.

A nurse is caring for a client who is experiencing an acute gout attack. The nurse should anticipate a prescription from the provider for which of the following medications? A. Colchicine B. Allopurinol C. Probenecid D. Pegloticase

Correct Answer: A. Colchicine The nurse should anticipate a prescription for colchicine because it is the medication of choice for an acute gout attack. The client can experience relief from the attack within hours of receiving this medication. Colchicine can also be prescribed for long-term use to prevent future attacks from occurring. Incorrect Answers: B. Allopurinol is the medication of choice for clients who have chronic tophaceous gout. Allopurinol acts by lowering the uric acid levels in the blood and reducing the development of new tophus formation, which are nodular masses resulting from increased uric acid levels producing uric crystals. However, it is not used to treat an acute gout attack. C. Probenecid is not indicated for a client who is experiencing an acute gout attack. This medication acts by lowering the plasma urate levels and increasing the excretion of uric acid in the urine. This can exacerbate an acute gout attack and is indicated once the acute gout attack is controlled. D. Pegloticase is an intravenous medication used to treat chronic gout that has not responded to the normal treatment. It is not indicated to treat an acute gout attack.

A nurse is providing discharge instructions for a client who is postoperative following inner maxillary fixation with wiring. Which of the following information should the nurse include? A. Cut the wiring if emesis occurs. B. Consume three meals daily as part of a low-protein diet. C. Swab the mouth with hydrogen peroxide if wiring produces oral irritation. D. Resume a soft diet in 3 to 5 days.

Correct Answer: A. Cut the wiring if emesis occurs. 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. Consume three meals daily as part of a low-protein diet. The nurse should encourage the client to consume adequate protein and calories for wound healing. Small, frequent meals can prevent nausea. Swab the mouth with hydrogen peroxide if wiring produces oral irritation. The nurse should instruct the client to report any irritation in the oral cavity to the provider. Resume a soft diet in 3 to 5 days. The nurse should instruct the client to consume a liquid diet for 1 to 4 weeks postoperatively.

A nurse is caring for a client who has asthma and advanced rheumatoid arthritis and deformity of the hands. The nurse should anticipate that the client will receive which of the following medication-delivery devices for the treatment of asthma? A. Dry-powder inhaler (DPI) B. Metered-dose inhaler (MDI) with spacer C. Respimat D. Nebulizer

Correct Answer: A. Dry-powder inhaler (DPI) The nurse should identify that DPIs do not require hand-breath coordination and are easier to use for clients who have deformities of the hands. DPIs are used to deliver medications in a dry, micronized powder directly to the lungs. Incorrect Answers: B. MDIs with spacer devices require hand-breath coordination in order to ensure maximum deposition of medication. This can be more difficult for a client who has deformity of the hands. C. Respimat inhalers deliver medication as a fine mist. Although these devices do not require as much handbreath coordination as MDIs, they still require the client to activate the device using a twisting motion, which can be more difficult for a client who has deformity of the hands. D. Nebulizers are small machines that convert liquid medication into a fine mist for inhalation. The medications used with nebulizers often require twisting of small ampules to open, which can be more difficult for a client who has deformity of the hands.

A nurse is caring for a client who has osteoporosis and a new prescription for calcium supplements. Which of the following foods should the nurse recommend to promote calcium absorption? A. Fortified milk B. Ripe bananas C. Steamed broccoli D. Green leafy vegetables

Correct Answer: A. Fortified milk Fortified milk provides 2.45 mcg of vitamin D, which promotes calcium absorption from the gastrointestinal tract. Adults up to age 70 need 600 international units of vitamin D per day and 800 international units thereafter. Therefore, fortified milk is a good source of vitamin D. Incorrect Answers: B. Bananas are a good source of potassium and can reduce bone loss. However, bananas do not promote calcium absorption. C. Broccoli is a good source of vitamin C, which is important for bone matrix formation. However, steamed broccoli does not promote calcium absorption. D. Green leafy vegetables are a good source of vitamin K. However, green leafy vegetables contain oxalic acid, which decreases calcium absorption.

A nurse is caring for an older adult client who has gout and refuses to eat. The client's provider has authorized the client's family to bring food from home. Which of the following foods should the nurse recommend that the client avoid? A. Lentil soup B. Cheese sandwich C. Yogurt D. Raisins

Correct Answer: A. Lentil soup The nurse should encourage the client to eat a purine-restricted diet to decrease elevated uric acid levels. This diet is recommended for clients who have gout, renal calculi, or both in conjunction with medication therapy. Whole-grain bread and cereal, oatmeal, wheat germ, wheat bran, meat gravy, fresh and saltwater fish, beans, organ meats, mushrooms, green peas, spinach, asparagus, cauliflower, and baker's and brewer's yeasts are all high in purine. Lentils, which are legumes, are a rich source of purines. Incorrect Answers: B. Ripe cheese is high in tyramine but not purine. MAOIs interfere with the inactivation of tyramine found in various foods, and adverse effects may occur with consumption of foods that contain tyramine. C. Yogurt is a good source of calcium, not purine. Many older adult clients, especially women, do not get enough calcium in their diets and require foods rich in calcium. D. Raisins are rich in potassium but not purine. A potassium-restricted diet helps prevent high blood potassium in clients who have renal failure.

A nurse is preparing to administer medication to a client who has gout. The nurse discovers that an error was made during the previous shift in which the client received atenolol instead of allopurinol. Which of the following interventions is the nurse's priority? A. Measure the client's apical pulse B. Administer the allopurinol to the client C. Inform the nurse manager D. Complete an incident report

Correct Answer: A. Measure the client's apical pulse The first action the nurse should take using the nursing process is to assess the client by measuring the client's apical pulse. Atenolol is a beta blocker and can decrease the client's heart rate. Incorrect Answers: B. The nurse should administer allopurinol to the client to ensure timely administration of medication. However, there is another action the nurse should take first. C. The nurse should inform the nurse manager and report the error. However, there is another action the nurse should take first. D. The nurse should complete an incident report for review to inform the risk manager of the medication error. However, there is another action the nurse should take first.

A nurse is caring for a client who is experiencing an acute gout attack. The nurse should anticipate a prescription from the provider for which of the following medications? A. Naproxen B. Pegloticase C. Probenecid D. Allopurinol

Correct Answer: A. Naproxen The nurse should anticipate that the provider will prescribe an NSAID such as naproxen. This type of medication is recommended as the first choice of treatment for relieving the manifestations of an acute gout attack. Incorrect Answers: B. Pegloticase is indicated for IV therapy for clients who have chronic gout and have not responded to oral urate-lowering therapy. Pegloticase is not indicated for an acute gout attack. C. Probenecid is not indicated for a client who is experiencing an acute gout attack. This medication acts by lowering the client's plasma urate levels and increasing the excretion of uric acid in the urine. This can exacerbate an acute gout attack and is indicated once the acute gout attack has already been controlled. D. Allopurinol is the medication of choice for clients who have chronic tophaceous gout. Allopurinol acts by lowering uric acid levels in the blood and reducing the development of new tophus formation, which are nodular masses created as a result of increased uric acid levels producing uric crystals. However, this medication is not used for the treatment of an acute gout attack.

A nurse in a provider's office is measuring a client and notes a loss in height from the previous year. The nurse should identify this finding as a manifestation of which of the following musculoskeletal system disorders? A. Osteoporosis B. Scoliosis C. Kyphosis D. Lordosis

Correct Answer: A. Osteoporosis A loss of height is often an early indication of osteoporosis. This occurs due to loss of calcium in the vertebrae, which can cause them to fracture and collapse. Incorrect Answers: B. Scoliosis does not precipitate a decrease in the height of a client. It is an abnormal lateral curve of the spine. C. Kyphosis does not precipitate a decrease in the height of a client. It is an exaggerated posterior curvature of the thoracic spine (i.e. hunchback). D. Lordosis does not precipitate a decrease in the height of a client. It is an exaggerated lumbar curvature (i.e. swayback).

A nurse is assessing a client who is 24 hr postoperative following an above-the-elbow amputation. Which of the following findings should the nurse identify as the priority? A. Report of muscle spasms B. Inability to get dressed without assistance C. Report of feelings of anger D. Refusal to look at the affected limb

Correct Answer: A. Report of muscle spasms 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 providing teaching to a client who has rheumatoid arthritis and a prescription for long-term prednisone therapy. The nurse should instruct the client to monitor for which of the following adverse effects? A. Stress fractures B. Orthostatic hypotension C. Gingival ulcerations D. Weight loss

Correct Answer: A. Stress fractures Prednisone can cause demineralization of the bones and can lead to osteoporosis and stress fractures. Incorrect Answers: B. Clients who take prednisone are at risk for hypertension due to sodium and fluid retention. C. Clients who take prednisone are not at risk for gingival ulcerations. D. Clients who take prednisone are at risk for weight gain due to water retention.

A nurse is assessing a client who is 48 hr postoperative following open reduction and internal fixation of a fractured tibia. Which the following findings should the nurse report to the provider? A. Toes cold to the touch B. Serous Drainage from the pin sites C. Blanching of the toenail beds with pressure D. Pink tissue around the fixator insertion sites

Correct Answer: A. Toes cold to the touch 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 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 B. Ask the provider to bivalve the cast C. Provide the client with sterile cotton swab to rub the affected skin D. Wrap the extremity with a dry heating pad

Correct Answer: A. Use a hair dryer on a cool setting to blow air into the cast.------ 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 caring for a client who was recently diagnosed with rheumatoid arthritis. The nurse should expect the provider to prescribe methotrexate at which of the following times? A. Within 3 months of the initial diagnosis B. When NSAIDs have not provided pain relief C. During an exacerbation of symptoms D. Once bone degeneration progresses

Correct Answer: A. Within 3 months of the initial diagnosis The nurse should identify that current guidelines recommend starting a disease-modifying antirheumatic drug (DMARD) such as methotrexate within 3 months of a diagnosis of rheumatoid arthritis to prevent or delay joint degeneration. Incorrect Answers: B. NSAIDs can be used along with DMARDs to control pain until the DMARDs take effect to limit the disease process. C. Glucocorticoids are frequently prescribed for the short-term management of symptom flare-ups and to control symptoms of rheumatoid arthritis until DMARDs take effect. D. During treatment with a DMARD, another DMARD can be added or substituted to assist with delaying bone degeneration or joint injury.

A nurse is preparing a client who is scheduled to have an arthroscopy the following day. Which of the following statements indicates that the client understands the pre-procedure teaching? A. "I have to keep my leg straight throughout the whole procedure." B. "The doctor will be able to see if I have signs of rheumatoid arthritis." C. "I should expect to stay overnight until I can walk around." D. "I'll have a scar that will be about an inch long."

Correct Answer: B. "The doctor will be able to see if I have signs of rheumatoid arthritis." An arthroscopy helps with diagnosing musculoskeletal disorders such as rheumatoid arthritis, osteoarthritis, and internal joint injuries. Incorrect Answers: A. The client has to be able to flex the knee at least 40° so the surgeon can insert the arthroscope into the joint space. C. An arthroscopy typically requires ambulatory or same-day surgery. Activity restrictions are likely; however, the client is allowed to ambulate after anesthesia recovery, most likely with crutches. D. The client might have several incisions that are typically about 0.6 cm (0.24 in) long

A nurse in the emergency department is assessing a client who was in a motor-vehicle crash 2 days ago and sustained fractures to his tibia, ulna, and several ribs. The client is now disoriented to time and place, has a SaO of 87%, and the nurse notes generalized petechiae on the client's skin. Which of the following complications should the nurse suspect? A. Hypovolemic shock B. Fat embolism syndrome C. Thrombophlebitis D. Avascular bone necrosis

Correct Answer: B. Fat embolism syndrome 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. Hypovolemic shock The nurse should suspect hypovolemic shock for a client who experiences hypotension following extreme fluid loss, as with uncontrolled bleeding, dehydration, or severe edema. • Thrombophlebitis The nurse should suspect thrombophlebitis for a client who reports redness and warmth over the involved vein, along with extremity pain. Avascular bone necrosis The nurse should suspect avascular bone necrosis as a long-term complication for a client who reports pain and limited movement. Radiographs of the extremity will reveal loss of bone structure

A nurse is assessing a client who has systemic scleroderma. Which of the following findings should the nurse expect? A. Excessive salivation B. Finger contractures C. Periorbital edema D. Alopecia

Correct Answer: B. Finger contractures Scleroderma is a chronic disease that can cause thickening, hardening, or tightening of the skin, blood vessels, and internal organs. There are 2 types of scleroderma: localized scleroderma, which mainly affects the skin, and systemic scleroderma, which can affect internal organs. Manifestations include skin changes, Raynaud's phenomenon, arthritis, muscle weakness, and dry mucous membranes. With scleroderma, the body produces and deposits too much collagen, causing thickening and hardening. In addition to the client's skin and subcutaneous tissues becoming increasingly hard and rigid, the extremities stiffen and lose mobility. Contractures develop with advanced systemic scleroderma unless clients follow a regimen of range-of-motion and muscle-strengthening exercises. Incorrect Answers: A. Clients who have systemic scleroderma experience decreased salivation, which increases the risk of dental caries and gum disease. C. Clients who have scleroderma develop ankle and pedal edema due to the constriction of blood vessels as a result of renal failure. D. Clients who have scleroderma can lose hair in affected areas; however, alopecia is not a finding associated with systemic scleroderma

A nurse is caring for a client who is in skeletal traction following a femur fracture. The nurse finds the client has slid down toward the foot of the bed and the traction weight is resting on the floor. Which of the following actions should the nurse take? A. Remove the weight temporarily to reposition the client to the correct alignment in bed. B. Have the client use a trapeze to pull himself up while ensuring the weight hangs freely. C. Lift the rope off the pulley while the client rocks back and forth to reposition. D. Lift the weight manually while another staff member moves the client up in bed.

Correct Answer: B. Have the client use a trapeze to pull himself up while ensuring the weight hangs freely. 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 caring for a client who is experiencing an acute exacerbation of rheumatoid arthritis. The nurse should anticipate that the client's affected joints will require which of the following treatments? A. An assistive device when the client is ambulating B. Heat paraffin therapy applied to the client's joints C. Gentle massage of the client's hands D. Active range-of-motion exercises on the client's affected joints

Correct Answer: B. Heat paraffin therapy applied to the client's joints The nurse should anticipate the use of heat paraffin to be prescribed as a nonpharmacological intervention. An elevated ESR indicates an acute inflammatory process due to client's rheumatoid arthritis. The use of the warm paraffin relieves the stiffness of the client's joints and provides comfort. Incorrect Answers: A. Clients who have rheumatoid arthritis do not need assistive devices. An assistive device is only needed when severe loss of range-of-motion occurs. C. Massage can aggravate inflammation. Most clients have a tendency to rub inflamed, aching joints but should be taught instead to massage over surrounding muscles, not joints. D. During exacerbations of rheumatoid arthritis, active range-of-joint motion exercises should not be performed; only passive or isometric exercises are indicated

A nurse is reviewing the medical record of a client with rheumatoid arthritis who has a prescription for infliximab. Which of the following findings should the nurse identify as a contraindication to the client receiving this medication? A. Psoriatic arthritis B. Hepatitis B virus C. Ulcerative colitis D. Ankylosing spondylitis

Correct Answer: B. Hepatitis B virus The nurse should identify that infliximab is a tumor necrosis factor (TNF) antibody medication that is used to reduce the disease manifestations and to delay disease progression. Infliximab has immunosuppressant properties that can increase the risk of infection. Clients who have an active or chronic infection such as hepatitis B virus should not take infliximab. Incorrect Answers: A. Psoriatic arthritis is a chronic disease characterized by inflammation of the skin and joints. TNF medications such as infliximab suppress inflammation by suppressing TNF, which can reduce the manifestations of psoriatic arthritis. C. Ulcerative colitis is an inflammatory bowel disease that affects the innermost lining of the colon. Treatment includes surgery and medication therapy, which can include TNF medications. D. Ankylosing spondylitis is a form of arthritis that primarily affects the spine, causing severe, chronic pain and discomfort. Infliximab is a TNF medication that can limit the progression of arthritis and decrease inflammation.

A nurse is reviewing the medical record of a client who has postmenopausal osteoporosis and a prescription for raloxifene. Which of the following findings in the client's medical record should the nurse identify as a contraindication to receiving this medication? A. Breast cancer B. History of deep-vein thrombosis (DVT) C. Allergy to calcitonin D. Current diagnosis of cholecystitis

Correct Answer: B. History of deep-vein thrombosis (DVT) The nurse should identify that a history of DVT is a contraindication for receiving raloxifene because this medication can cause DVT in clients who have a prior history. Therefore, the nurse should notify the provider of this finding and request an alternative medication prescription for the client. Incorrect Answers: A. Raloxifene can be used to prevent and treat breast cancer. Therefore, breast cancer is not a contraindication to receiving this medication. C. An allergy to calcitonin is not a contraindication to receiving raloxifene. If a client is unable to take calcitonin for postmenopausal osteoporosis due to an allergy to salmon calcitonin, raloxifene can be prescribed as an alternative. D. Cholecystitis is not a contraindication to receiving raloxifene. This medication is a safe treatment alternative for clients who have cholecystitis.

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. Sensation of heat on the surface of the cast • B. Paresthesias of the extremity C. Pruritus of the extremity D. Musty odor noted from cast materials

Correct Answer: B. Paresthesias of the extremity 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. Sensation of heat on the surface of the cast The nurse should expect the cast to feel hot immediately following application due to a chemical reaction in the casting materials. • Pruritus of the extremity The nurse should identify pruritus as an indication of possible cast irritation and implement measures to provide relief. Musty odor noted from cast materials The nurse should expect a new plaster cast to feel damp and have a musty odor for 24 to 72 hr until drying is complete

A nurse is assigned to care for several clients who are postoperative. The client taking which of the following medications is at risk of delayed wound healing? A. Nifedipine to treat hypertension B. Prednisone to treat persistent arthritis exacerbations C. Albuterol to treat asthma D. Chlorpromazine to treat schizophrenia

Correct Answer: B. Prednisone to treat persistent arthritis exacerbations Prednisone is a corticosteroid that is associated with delayed wound healing. Clients who have arthritis often require high doses of prednisone to help resolve exacerbations. Incorrect Answers: A. Nifedipine does not affect wound healing; however, it can cause dermatitis and urticaria. C. Albuterol does not affect wound healing and does not cause integumentary effects. D. Chlorpromazine does not affect wound healing; however, it can cause dermatitis and eczema.

A nurse is caring for a client who is showing evidence of addiction to a pain medication prescribed for rheumatoid arthritis. When questioned about the usage of the medication, the client states, "It is not an illegal drug." Which of the following defense mechanisms is the client using? A. Displacement B. Rationalization C. Projection D. Sublimation

Correct Answer: B. Rationalization Rationalization is the justification of unacceptable behavior by offering acceptable explanations. This is also known as making excuses. Incorrect Answers: A. Displacement is the transference of feelings for a person or situation to a less threatening one. C. Projection is an immature and unconscious defense of an impulse or feeling by denying its existence. D. Sublimation is a mature defense mechanism in which unaccepted impulses are unconsciously replaced by accepted activities.

A nurse is caring for a client who has rheumatoid arthritis and a new prescription for etanercept. Which of the following values should the nurse review prior to the administration of the medication? A. Ability to swallow B. Results of last purified protein derivative (PPD) test C. Serum creatinine level D. Blood glucose level

Correct Answer: B. Results of last purified protein derivative (PPD) test The nurse should identify that a client who is taking etanercept is at risk for infections such as tuberculosis (TB). To reduce this risk, the client should be tested for latent TB; if the test is positive, the client should undergo TB treatment before receiving etanercept. During treatment with etanercept, the client should be monitored closely for the development of TB. Incorrect Answers: A. Etanercept is administered via injection. The client's ability to swallow should not affect the administration of this medication. C. Etanercept does not require the nurse to review the client's serum creatinine level prior to the administration because this medication is not contraindicated in clients who have renal impairment and does not cause nephrotoxicity. However, it can cause injury to the liver. Therefore, liver function tests should be completed periodically. D. Etanercept does not affect a client's blood glucose level. However, clients who have diabetes mellitus have an increased risk of infection.

A nurse is reviewing the laboratory results for a client who reports bilateral pain and swelling in her finger joints, with stiffness in the morning. The nurse should recognize that an increase in which of the following laboratory values can indicate arthritis? A. Reticulocyte count B. Rheumatoid factor C. Direct Coombs' test D. Platelet count

Correct Answer: B. Rheumatoid factor An increase in the client's rheumatoid factor can indicate rheumatoid arthritis or other connective tissue diseases. Incorrect Answers: A. An increase in the client's reticulocyte count can indicate chronic loss of blood, not arthritis. C. An increase in the client's direct Coombs' test can indicate the presence of antibodies to RBCs, not arthritis. D. An increase in the client's platelet count can indicate polycythemia, not arthritis.

A nurse is caring for a client who is 3 days postoperative 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. Bulging in the area over the surgical incision B. Shortening of the right leg C. Sensation of warmth over the surgical incision D. Pallor following elevation of the right leg

Correct Answer: B. Shortening of the right leg 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. Bulging in the area over the surgical incision The nurse should not expect visible bulging following dislocation of the prosthesis. • Sensation of warmth over the surgical incision The nurse should not expect a sensation of warmth over the surgical incision following dislocation of the prosthesis. A sensation of warmth or heat can indicate infection of the joint. Pallor following elevation of the right leg The nurse should not expect pallor following elevation of the right leg following dislocation of the prosthesis. This finding is expected for a client who has impaired arterial circulation

A nurse in a provider's office is providing teaching to a client with osteoporosis who has a new prescription for alendronate sodium. Which of the following pieces of information should the nurse include? A. Alendronate sodium can be administered by IV once yearly. B. Take alendronate sodium with a full glass of water on an empty stomach. C. Side effects of alendronate sodium include leukopenia. D. Alendronate sodium should be taken with calcium-containing foods to increase absorption.

Correct Answer: B. Take alendronate sodium with a full glass of water on an empty stomach. Alendronate sodium should be taken with at least 230 mL (8 oz) of water 30 min before ingesting foods. An upright position is recommended after taking alendronate sodium to decrease the risk of esophagitis. Incorrect Answers: A. Alendronate sodium is a bisphosphonate that is given by mouth only. C. Common side effects of alendronate sodium include esophageal irritation, musculoskeletal pain, atypical femur fractures, and osteonecrosis of the jaw. D. After taking alendronate sodium, the client should not eat or drink anything but water for at least 30 minutes. Calcium supplements should also not be taken within 30 minutes of consuming alendronate sodium.

A nurse is providing teaching to an adolescent client who has juvenile idiopathic arthritis. Which of the following instructions should the nurse include in the teaching? A. "Apply cold compresses to relieve your joint pain." B. "Take opioids routinely." C. "Attend school regularly." D. "Adhere to an arthritis diet."

Correct Answer: C. "Attend school regularly." The nurse should encourage this adolescent with idiopathic arthritis to attend school. The adolescent should attend school even on days when joint pain or stiffness occurs. Incorrect Answers: A. The client should apply moist heat to relieve joint pain and stiffness. B. Opioid pain medications are not routinely prescribed for pain associated with juvenile idiopathic arthritis. The nurse should instruct the client to take NSAIDs on a routine schedule to maintain adequate therapeutic levels. D. There is no "arthritis diet" or certain foods for the adolescent to avoid to decrease symptoms of arthritis. However, to avoid excessive weight gain, the client should monitor and match the caloric intake to individual energy needs.

A nurse is teaching an older adult client about osteoporosis. Which of the following statements should the nurse include in the teaching? A. "Cottage cheese is a good source of calcium." B. "Increase your caffeine intake." C. "Brisk walking will help prevent bone loss." D. "Hormone replacement therapy with estrogen will increase your risk of osteoporosis."

Correct Answer: C. "Brisk walking will help prevent bone loss." The nurse should encourage weight-bearing exercises to help minimize bone loss in the older adult client. A sedentary lifestyle, however, leads to a loss of minerals in the bones, especially calcium and phosphorus. Incorrect Answers: A. The nurse should include dietary sources of calcium and vitamin D in the teaching. Cottage cheese, however, is not a good source of calcium due to processing. B. The nurse should encourage the client to limit caffeine intake because it enhances the excretion of calcium. D. The nurse should provide information about medications for the prevention and treatment of osteoporosis. Estrogen can reduce the fracture rate in women who have osteoporosis, although other complications are related to its use, such as cancer.

A nurse is caring for a client who is postoperative following shoulder surgery. The client has a prescription to keep the affected arm adducted. Which of the following instructions should the nurse provide the client? A. "Keep your arm bent at the elbow." B. "Use a pillow to prop your shoulder up close to your ear." C. "Hold your arm against the side of your body." D. "Position your arm with the shoulder at a 90-degree angle."

Correct Answer: C. "Hold your arm against the side of your body." Adduction means to position toward the midline of the body. Therefore, the nurse should provide these instructions to explain the provider's prescription. "Keep your arm bent at the elbow." The nurse should provide these instructions for a client who is prescribed elbow flexion. "Use a pillow to prop your shoulder up close to your ear." The nurse should provide these instructions for a client who is prescribed shoulder elevation. "Position your arm with the shoulder at a 90-degree angle." The nurse should provide these instructions for a client who is prescribed shoulder abduction, moving the arm away from the midline of the body.

A nurse in a provider's office is teaching a client with a recent diagnosis of rheumatoid arthritis who has a new prescription for naproxen tablets. Which of the following statements by the client indicates the need for further teaching? A. "After taking this medication for 4 weeks, I'll start to notice relief in my joints." B. "I can take an antacid with this medication for indigestion." C. "I can take this medication with aspirin." D. "The naproxen goes down easier when I crush it and put it in applesauce."

Correct Answer: C. "I can take this medication with aspirin." The nurse should instruct the client to avoid taking this medication with any other NSAIDs such as aspirin because this can increase the risk of bleeding and gastrointestinal ulceration. Incorrect Answers: A. The therapeutic effects of naproxen will not be evident until 3 to 4 weeks of taking the medication. B. NSAIDs such as naproxen can cause serious adverse gastrointestinal upset (e.g. nausea, vomiting, and indigestion). An antacid is commonly prescribed to take with this medication. D. Naproxen tablets can be crushed or swallowed whole. Medications that are enteric-coated or have sustainedrelease properties should not be crushed.

A nurse is providing preoperative 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 will wear a continuous movement machine on my knee for 24 hours a day." B. "I should avoid taking NSAID medications for pain after surgery." C. "I should wear elastic stockings on both of my legs." D. "I will begin exercising my legs the day after surgery."

Correct Answer: C. "I should wear elastic stockings on both of my legs." 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 "I will wear a continuous movement machine on my knee for 24 hours a day." The nurse should instruct the client that a continuous passive motion (CPM) machine is usually prescribed for a few hours at a time several times a day. Not all clients are prescribed CPM therapy following total knee arthroplasty. "I should avoid taking NSAID medications for pain after surgery." The nurse should remind the client that pain will be initially controlled with epidural or patient-controlled analgesia and supplemented by other analgesic medications, including NSAIDs. • "I will begin exercising my legs the day after surgery." The nurse should instruct the client to begin leg exercises while in bed during the immediate postoperative period, including heel pumps and quadriceps setting exercises.

A nurse is providing teaching about disease management to a client who has rheumatoid arthritis. Which of the following responses by the client indicates an understanding of the teaching? A. "I will take a hot bath every morning to decrease my stiffness." B. "When my arthritis acts up, I will rest all day and avoid exercising." C. "I will have handrails installed in my bathroom and hall." D. "I will avoid taking naps so I sleep better at night."

Correct Answer: C. "I will have handrails installed in my bathroom and hall." The nurse should instruct the client to have handrails installed in the bathroom and hall to promote safety as the disease progresses. Incorrect Answers: A. The nurse should instruct the client to take a hot shower to decrease morning stiffness. Getting in and out of a bathtub is a safety risk for a client who has rheumatoid arthritis. B. Immobility will further hinder joint movement and should be avoided. Gentle exercise of the affected extremities should be performed, even when joints are painful and inflamed. A physical therapy regimen might be required. D. The client should balance activity with rest by taking 1 or 2 naps during the day.

A nurse is providing teaching for a client who has gout and a prescription for allopurinol. Which of the following statements by the client should indicate to the nurse that the teaching was effective? A. "I should start taking this medication at 800 mg daily." B. "I will have an increased risk for diabetes with this medication." C. "I will increase my fluids to at least 2 liters per day." D. "I should take this medication twice daily."

Correct Answer: C. "I will increase my fluids to at least 2 liters per day." The nurse should identify that an adverse effect of allopurinol is renal injury. Therefore, clients are encouraged to drink at least 2,000 mL/day to maintain a urine output of at least 2 L/day. Incorrect Answers: A. The initial dosage for allopurinol begins at 100 mg daily. This dose can be increased every few weeks to control manifestations of gout. The provider can increase this dosage to a maximum of 800 mg/day. B. Allopurinol may cause hypoglycemia in clients who are taking oral hypoglycemic agents. However, this medication is not associated with an increased risk for the development of diabetes mellitus. D. Allopurinol is typically prescribed once daily due to its prolonged half-life.

A nurse is providing teaching to a client who has postmenopausal osteoporosis and a new prescription for intranasal calcitonin-salmon. Which of the following statements by the client indicates an understanding of the teaching? A. "I will administer a spray into each nostril daily." B. "I should expect nasal bleeding for the first week." C. "I will need to depress the side arms to activate the pump." D. "I should expect to take this medication for a short-term course of treatment."

Correct Answer: C. "I will need to depress the side arms to activate the pump." The nurse should instruct the client to activate the pump for the initial use by holding the bottle upright and depressing both white side arms toward the bottle 6 times. Incorrect Answers: A. The nurse should instruct the client to administer calcitonin-salmon to a single nostril daily, alternating nostrils. B. The nurse should instruct the client that nasal bleeding or ulcerations are indications to discontinue the medication and to notify the provider if nasal bleeding occurs. D. Calcitonin-salmon is a long-term treatment therapy for postmenopausal osteoporosis. The medication has no documented long-term adverse effects. Peer Comparison A

A nurse is teaching a client who has osteoporosis and a new prescription for alendronate. Which of the following client statements indicates that the teaching was effective? A. "I should take the medication with a glass of orange juice." B. "I will allow the medication to dissolve in my mouth." C. "I will sit upright for 30 minutes after taking the medication." D. "I should take the medication right after eating breakfast."

Correct Answer: C. "I will sit upright for 30 minutes after taking the medication." The nurse should instruct the client to sit upright or stand for at least 30 minutes after taking the medication to prevent esophagitis. Incorrect Answers: A. Esophagitis is an adverse effect of alendronate. To minimize the risk of esophagitis, the nurse should instruct the client to take the medication with a full glass of water and not to take it with orange juice or coffee. B. The nurse should instruct the client to take alendronate by mouth with a full glass of water. The client should avoid chewing or sucking on the medication. D. Absorption of alendronate is significantly diminished when taken with food. The medication is to be taken on an empty stomach, and the client should wait 30 minutes before consuming food or drink.

A nurse is teaching a client who has been taking an NSAID to treat rheumatoid arthritis. During the client's first month checkup, the provider prescribed methotrexate to be added to the medication regimen. Which of the following statements should the nurse include in the teaching about the purpose of this change in the client's medication? A. "Your current medication was not strong enough to manage this condition." B. "Once your blood levels of methotrexate are within the therapeutic range, the NSAID will be discontinued." C. "This medication was added to delay the disease progression." D. "Treating this disease with 2 medications will help protect you from becoming treatment-resistant."

Correct Answer: C. "This medication was added to delay the disease progression." The nurse should inform the client that the provider prescribed methotrexate to be added to the medication regimen along with an NSAID to delay the progression of the disease and to delay joint damage or deformity that can result from the disease.

A nurse is caring for a client who is postoperative 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. Remind the client to push the button for the PCA device. B. Discuss activities the client may use to distract from the pain. C. Ask the client to describe the characteristics of the pain. D. Pause the CPM machine briefly to apply a cold pack to the client's knee.

Correct Answer: C. Ask the client to describe the characteristics of the pain. 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. Remind the client to push the button for the PCA device. The nurse should remind the client to push the button for the PCA device to promote the client's understanding of the PCA and facilitate consistent pain control, but there is a different action the nurse should take first. • Discuss activities the client may use to distract from the pain. The nurse should discuss activities the client may use to distract from the pain to provide nonpharmacological pain relief measures, but there is a different action the nurse should take first. Pause the CPM machine briefly to apply a cold pack to the client's knee. The nurse should stop the CPM machine briefly to apply a cold pack to the client's knee to help reduce edema of the joint as a non-pharmacological pain relief measure, but there is a different action the nurse should take

A nurse is performing medication reconciliation for a newly admitted client who has rheumatoid arthritis (RA). Which of the following medications should the nurse identify as the treatment for this condition? A. Misoprostol B. Dantrolene C. Celecoxib D. Colchicine

Correct Answer: C. Celecoxib 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. • Misoprostol Misoprostol is a histamine-blocking agent. A client who has RA may be prescribed misoprostol to prevent adverse gastrointestinal effects of taking an NSAID, but it does not treat manifestations of RA. Dantrolene Dantrolene is an anti-spasmodic medication prescribed to relieve muscle spasms for clients who have multiple sclerosis. Colchicine Colchicine is an anti-inflammatory medication prescribed to relieve pain for clients who have gout.

A nurse is assessing a female client who reports severe joint pain. The nurse should identify that which of the following factors places the client at risk for gout? A. Perimenopause B. Migraine headaches C. Diuretic use D. Irritable bowel syndrome

Correct Answer: C. Diuretic use The client's use of diuretics is a risk factor for gout. Gout is a systemic disorder that affects the joints as a result of high uric acid levels in the blood. Incorrect Answers: A. A client who is postmenopausal is at risk for gout. B. Migraine headaches are a risk factor for fibromyalgia. D. Irritable bowel syndrome is a risk factor for fibromyalgia.

A nurse is planning care for a school-aged child who has juvenile idiopathic arthritis (JIA). Which of the following actions should the nurse include in the plan? A. Encourage the child to sleep for 1 hour each afternoon B. Apply cold compresses to the child's affected joints each morning C. Encourage the child to participate in physical activities D. Limit the child's intake of foods that are high in uric acid

Correct Answer: C. Encourage the child to participate in physical activities The nurse should encourage the child to remain physically active to promote mobility and joint function. Incorrect Answers: A. The nurse should discourage the child from sleeping during the daytime. Children who have JIA have interrupted sleep patterns. Therefore, the nurse should encourage 30 to 60 minutes of quiet play instead of napping to improve nighttime sleep. B. The nurse should apply moist heat compresses to the child's affected joints or provide a long bath each morning to alleviate stiffness and pain. D. The nurse does not need to limit any specific foods for a child who has JIA. The child should maintain a healthy weight to decrease pressure on joints.

A nurse is reviewing the medical record of a client who is postmenopausal and has osteoporosis. The client has a new prescription for alendronate sodium. Which of the following findings in the client's history should the nurse recognize is a contraindication to this medication? A. Glaucoma B. Paget's disease C. Esophageal achalasia D. Long-term corticosteroid use

Correct Answer: C. Esophageal achalasia Clients with a history of esophageal abnormalities like stricture or achalasia have delayed esophageal emptying, which greatly increases the client's risk of esophageal erosion, bleeding, and perforation. Alendronate sodium is a bisphosphonate, which prevents or slows bone weakening. It is used to prevent and treat postmenopausal osteoporosis. The nurse should instruct the client to wait at least 30 minutes after taking alendronate sodium before eating, drinking, or taking other medications and caution her not to lie down for at least 30 minutes after taking the medication. Standing or sitting upright ensures the client gets the full dose and decreases heartburn or the risk of injury to the esophagus.

A nurse is providing teaching to a client who has gout and a new prescription for allopurinol. The nurse should instruct the client to discontinue taking the medication for which of the following adverse effects? A. Nausea B. Metallic taste C. Fever D. Drowsiness

Correct Answer: C. Fever A fever can indicate a potentially fatal hypersensitivity reaction. The client should discontinue allopurinol and notify the provider if a fever or rash develops. Incorrect Answers: A. Mild gastrointestinal adverse effects (e.g. nausea, vomiting, abdominal pain, and diarrhea) can occur with allopurinol. The client should take the medication with food to reduce these effects. B. Metallic taste is a mild adverse effect of allopurinol. The nurse should inform the client that this can occur and not to discontinue the medication. D. Drowsiness is a mild adverse effect of allopurinol. The nurse should inform the client that this can occur and not to discontinue the medication.

A nurse is teaching a client who has severe generalized rheumatoid arthritis and is scheduled to start taking prednisone for long-term therapy. The nurse should instruct the client to report which of the following as an adverse effect of prednisone? A. Thrombosis B. Immunosuppression C. Gastric ulceration D. Liver toxicity

Correct Answer: C. Gastric ulceration The nurse should instruct the client to monitor for gastric ulceration as an adverse effect of the long-term use of prednisone. Other adverse effects of this medication include osteoporosis and adrenal suppression. Incorrect Answers: A. The nurse should identify that NSAIDs can selectively inhibit COX-2 and can increase the risk of thrombotic events. B. The nurse should identify that non-biological disease-modifying anti-rheumatic drugs (DMARDs) can cause immunosuppression. D. The nurse should identify that methotrexate, which is a DMARD, can cause hepatotoxicity.

A nurse is caring for a client who has osteoporosis and has been taking a vitamin D supplement. The nurse notes that the client reports also taking a multivitamin daily. Which of the following findings should indicate to the nurse that the client might be experiencing vitamin D toxicity? A. Hyperkalemia B. Hypermagnesemia C. Hypercalcemia D. Hypernatremia

Correct Answer: C. Hypercalcemia The nurse should identify that vitamin D increases plasma calcium levels by increasing reabsorption from bone, decreasing excretion by the kidneys and increasing absorption from the intestines. Clients who take a vitamin D supplement along with a multivitamin daily might be taking too much calcium. Incorrect Answers: A. Potassium-sparing diuretics work by decreasing kidney excretion of potassium. Increased potassium levels can occur when clients take a prescribed potassium-sparing diuretic along with a daily multivitamin that contains potassium. B. Magnesium hydroxide, an antacid, is an alkaline compound that neutralizes stomach acid. Clients who take an excessive amount of magnesium hydroxide are at risk for magnesium toxicity. D. Mineralocorticoids promote the reabsorption of sodium and water in the kidneys. When doses of prescribed mineralocorticoids are too high, the client can retain excess sodium and water.

A nurse is caring for a client who has a pelvic fracture. The client reports sudden shortness of breath, stabbing chest pain, and feelings of doom. The nurse should identify that the client is experiencing which of the following complications? A. Pneumonia B. Pulmonary embolus C. Tension pneumothorax D. Tuberculosis

Correct Answer: C. Pulmonary embolus----- 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 preparing a community education program about reducing the risk of osteoporosis. Which of the following pieces of information should the nurse include? A. Avoid sun exposure. B. Take a calcium supplement once each day if at risk for osteoporosis. C. Walking is the preferred mode of exercise to maintain strong bones. D. Caffeine intake minimizes the risk of developing osteoporosis.

Correct Answer: C. Walking is the preferred mode of exercise to maintain strong bones. The nurse should emphasize that regular walks are the preferred weight-bearing exercise to build and maintain strong bones. Incorrect Answers: A. The nurse should include in the education program that sunlight exposure is important to ensure an adequate supply of vitamin D. B. Supplementation of 1 to 1.5 g of calcium in divided doses daily will help promote strong bones. D. Excessive caffeine intake increases the risk of developing osteoporosis.

A nurse is teaching a client with arthritis who is experiencing joint pain that impairs mobility. Which of the following instructions should the nurse include? A. "Engage your joints in resistance exercises." B. "Avoid using assistive devices when walking." C. "Perform passive exercises." D. "Apply heat to your joints prior to exercising."

Correct Answer: D. "Apply heat to your joints prior to exercising." The nurse should instruct the client to apply heat to the joints prior to exercising to increase mobility and reduce pain. Incorrect Answers: A. The nurse should instruct the client to avoid resistance exercise because it can cause joint injury when joints are soft and inflamed. B. The nurse should instruct the client to use assistive devices when walking to promote independence and increase mobility. C. The nurse should instruct the client to perform active exercises when possible to increase mobility.

A nurse is assessing a client with rheumatoid arthritis who has been taking high doses of prescribed hydroxychloroquine. Which of the following client statements should indicate to the nurse that the client is experiencing an adverse effect of hydroxychloroquine? A. "I have developed sores in my mouth." B. "I often feel like the room is spinning." C. "I noticed that the whites of my eyes look yellow." D. "I have had a change in my vision recently."

Correct Answer: D. "I have had a change in my vision recently." The nurse should identify that hydroxychloroquine is an antimalarial medication used to treat rheumatoid arthritis. Clients who take hydroxychloroquine in high doses are at risk for developing retinopathy, which can be irreversible and cause blindness. Incorrect Answers: A. Methotrexate is a disease-modifying antirheumatic drug (DMARD) that causes immunosuppression, which decreases manifestations of rheumatoid arthritis. Methotrexate can cause gastrointestinal tract ulceration. B. Minocycline is a tetracycline antibiotic that can improve the manifestations of rheumatoid arthritis when an infectious etiology is suspected. Clients who are experiencing an adverse effect of minocycline might report dizziness. C Leflunomide is an immunosuppressant medication used to slow the progression of rheumatoid arthritis

A nurse is teaching a client who has a new prescription for alendronate for treatment of osteoporosis. Which of the following statements by the client indicates understanding of the teaching? A. "I will take the medication in the evening." B. "I will drink a full glass of milk with the medication." C. "I will take the medication at mealtime." D. "I will sit upright after taking the medication."

Correct Answer: D. "I will sit upright after taking the medication." 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 teaching a client who has severe chronic gout and a new prescription for pegloticase. The client has been taking allopurinol for 1 month. Which of the following instructions should the nurse include about pegloticase? A. "You will take this medication along with allopurinol." B. "You will take this medication by mouth." C. "There are very few adverse effects of this medication." D. "If you experience a flare-up, you can take an NSAID while receiving this medication."

Correct Answer: D. "If you experience a flare-up, you can take an NSAID while receiving this medication." The nurse should instruct this client who has chronic gout that, during the first few months of treatment, an increase in gout manifestations is expected. To reduce the intensity of these manifestations, clients are instructed to take an NSAID such as Naproxen. Incorrect Answers: A. Allopurinol is the first medication of choice when a client is initially diagnosed with chronic gout. Pegloticase can be prescribed if treatment with allopurinol has been unsuccessful. B. Pegloticase is administered intravenously. It is a recombinant form of uric oxidase that inhibits the reabsorption of uric acid in clients who have chronic gout. C. Pegloticase has several severe adverse effects such as anaphylaxis. Manifestations include difficulty breathing, periorbital edema, wheezing, and a rash. Therefore, precautions should be taken such as pre-medicating the client with an antihistamine and reducing the rate of the infusion if necessary

A nurse is discussing the difference between rheumatoid arthritis (RA) and osteoarthritis with a newly licensed nurse. Which of the following information should the nurse include about osteoarthritis? A. "Osteoarthritis is caused by autoimmune processes." B. "Osteoarthritis leads to a decreased erythrocyte sedimentation rate." C. "Osteoarthritis affects other organ systems." D. "Osteoarthritis can impair a joint on a single side of the body."

Correct Answer: D. "Osteoarthritis can impair a joint on a single side of the body." The nurse should identify unilateral joint involvement as a finding of osteoarthritis. A client who has RA experiences symmetrical joint impairment. "Osteoarthritis is caused by autoimmune processes." The nurse should identify aging as a risk factor that causes degenerative changes in osteoarthritis. RA is an autoimmune disease in which the body's immune system attacks itself. "Osteoarthritis leads to a decreased erythrocyte sedimentation rate." The nurse should expect an increased erythrocyte sedimentation rate for a client who has osteoarthritis. • "Osteoarthritis affects other organ systems." The nurse should recognize that osteoarthritis is limited to the joints. RA is a systemic autoimmune disease, involving other body organs.

A nurse is discussing the difference between rheumatoid arthritis (RA) and osteoarthritis with a newly licensed nurse. Which of the following pieces of information should the nurse include about osteoarthritis? A. "Osteoarthritis is caused by autoimmune processes." B. "Osteoarthritis leads to a decreased erythrocyte sedimentation rate." C. "Osteoarthritis affects other organ systems." D. "Osteoarthritis can impair a joint on a single side of the body."

Correct Answer: D. "Osteoarthritis can impair a joint on a single side of the body." The nurse should identify unilateral joint involvement as a finding of osteoarthritis. A client who has RA experiences symmetrical joint impairment. Incorrect Answers: A. The nurse should identify aging as a risk factor that causes degenerative changes in osteoarthritis. RA is an autoimmune disease in which the body's immune system attacks itself. B. The nurse should expect an increased erythrocyte sedimentation rate for a client who has osteoarthritis. C. Osteoarthritis is limited to the joints. RA is a systemic autoimmune disease, involving other body organs.

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 information should nurse include? A. "You will need to apply a cold pack to the site three times a day." B. "Your provider might ask you to walk frequently to increase circulation to the area." C. "You will need to limit consumption of high-protein foods." D. "Your provider might prescribe a central catheter line for long-term antibiotic therapy."

Correct Answer: D. "Your provider might prescribe a central catheter line for long-term antibiotic therapy." 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 "You will need to apply a cold pack to the site three times a day." Cold therapy is contraindicated for a client who has an open wound. Cold causes decreased blood flow, which can further damage the impaired tissue. • "Your provider might ask you to walk frequently to increase circulation to the area." The client is at increased risk for fracture of the weakened bone. Therefore, the nurse should instruct the client to limit weight-bearing as prescribed by the provider. "You will need to limit consumption of high-protein foods." The nurse should recommend the client consume a diet high in protein to support wound healing.

A nurse is caring for a client who states that she does not want to get out of bed due to pain from arthritis. Which of the following actions should the nurse take? A. Tell the client the provider does not want her to remain in bed B. Allow the client to remain in bed until her pain subsides C. Instruct the family to perform ADLs for the client D. Advise the client to perform range-of motion exercises while in bed

Correct Answer: D. Advise the client to perform range-of-motion exercises while in bed Performing range-of-motion exercises will help the client maintain mobility until her pain is under control and she is able to ambulate without excessive discomfort. Incorrect Answers: A. This is a nontherapeutic response that implies the client should do what the provider wants and suggests the client has no input or control over her situation. B. Allowing the client to remain in bed could place the client at risk of complications of immobility, such as thrombus formation. C. Having the family perform ADLs for the client limits the client's independence.

A nurse in the emergency department is preparing to discharge a client following a Grade II (moderate) ankle sprain. Which of the following instructions should the nurse plan to give to the client? A. Perform passive range-of-motion exercises of the ankle hourly. B. Keep the affected extremity in a dependent position. C. Wrap a loose dressing around the affected ankle. D. Apply cold compresses to the extremity intermittently.

Correct Answer: D. Apply cold compresses to the extremity intermittently. 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. Perform passive range-of-motion exercises of the ankle hourly. The nurse should instruct the client to keep the ankle immobilized while the sprain heals. Keep the affected extremity in a dependent position. The nurse should instruct the client to elevate the extremity to decrease swelling. Wrap a loose dressing around the affected ankle. The nurse should instruct the client to apply a compression dressing to decrease swelling of the affected area. •

A nurse is caring for a client who takes sulfasalazine twice daily for rheumatoid arthritis. Which of the following values should the nurse review prior to the administration of the medication? A. Respirations B. Serum creatinine level C. Blood pressure D. Complete blood count

Correct Answer: D. Complete blood count The nurse should identify that sulfasalazine can cause bone marrow suppression, which can lead to agranulocytosis, hemolytic anemia, and macrocytic anemia. As a result, the client's complete blood count should be periodically monitored, and the nurse should review it prior to administering this medication. Incorrect Answers: A. Sulfasalazine does not affect respirations. Therefore, the nurse does not need to monitor the client's respirations prior to administering this medication. B. Sulfasalazine is excreted by the kidneys and does not have nephrotoxic properties. The nurse does not need to monitor the client's serum creatinine level prior to administering this medication. C. Sulfasalazine does not affect blood pressure. Therefore, the nurse does not need to monitor the client's blood pressure prior to administering this medication.

A nurse is assessing an older adult client. Which of the following findings should the nurse report to the provider? A. Decreased cough reflex B. Decreased urinary bladder capacity C. Decreased sebum production D. Decreased spinal column movement

Correct Answer: D. Decreased spinal column movement The nurse should report an onset of lower back tenderness and restricted spinal column movement, which can indicate a compression fracture due to osteoporosis. Incorrect Answers: A. A decreased cough reflex is a physiological change that can occur with aging. This change can increase the client's risk of infections such as pneumonia and bronchitis. B. Decreased urinary bladder capacity as a physiological change that can occur with aging. This change can increase the client's risk of conditions such as urinary incontinence. C. Decreased sebum production is a physiological change that can occur with aging. This change can increase the client's risk of conditions such as dry, cracking skin and xerosis.

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. Decreased intake of phosphate-containing foods B. Spending several hours in the sun daily C. Increased estrogen levels D. History of anorexia nervosa

Correct Answer: D. History of anorexia nervosa 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 reviewing the medical record of a female client. Which of the following findings should the nurse identify as a risk factor for osteoporosis? A. Decreased intake of phosphate-containing foods B. Spending several hours in the sun daily C. Increased estrogen levels D. History of anorexia nervosa

Correct Answer: D. History of anorexia nervosa The nurse should identify anorexia nervosa as a risk factor for osteoporosis. Inadequate protein intake can lead to decreased bone density, increasing the risk of fractures. Incorrect Answers: A. An increased intake of phosphate-containing foods, such as carbonated beverages, is a risk factor for osteoporosis. B. A lack of time outdoors in sunlight is a risk factor for osteoporosis. C. Decreased estrogen or testosterone is a risk factor for osteoporosis

A nurse is assessing a client who has several risk factors for osteoporosis. Which of the following findings indicates that the client requires further evaluation for this disorder? A. Leg cramps with exercise B. Stress incontinence C. Abdominal distention D. Lower back pain

Correct Answer: D. Lower back pain Lower back pain is common among clients who have osteoporosis, especially when they lift, stoop, or bend. Back pain and tenderness that cause movement restriction might indicate vertebral compression fractures, which are the most common type of fracture resulting from osteoporosis. Incorrect Answers: A. Leg cramps are not a symptom of osteoporosis. A variety of imbalances such as deficiencies of calcium and magnesium can cause muscle cramps. B. Stress incontinence is not a symptom of osteoporosis. Weakening of the bladder neck supports as a result of childbirth or anatomical damage to the urethral sphincter cause this disorder. C. Abdominal distention is not a symptom of osteoporosis. It can be a sign of gastrointestinal disorders such as irritable bowel syndrome and intestinal obstruction.

A nurse is caring for a client who is taking a prescription for glucocorticoid adrenal replacement medication for the long-term treatment of Addison's disease. Which of the following findings indicates that the client is experiencing an adverse effect of the medication? A. Weight loss B. Hypotension C. Lethargy D. Osteoporosis

Correct Answer: D. Osteoporosis Long-term use of steroid medications such as glucocorticoid medication can inhibit bone growth and result in the adverse effect of osteoporosis with long-term treatment. Incorrect Answers: A. The nurse should identify that long-term treatment with a glucocorticoid can result in weight gain due to sodium and water retention. B. The nurse should identify that long-term treatment with a glucocorticoid can result in hypertension due to sodium and water retention. C. The nurse should identify that long-term treatment with a glucocorticoid can result in restlessness, agitation, anxiety, and irritability rather than lethargy.

A nurse is teaching a client who has osteoporosis. Which of the following instructions should the nurse include in the teaching? A. Reduce dietary protein intake B. Apply ice to painful areas C. Increase calcium intake to 900 mg per day D. Perform weight-bearing exercises

Correct Answer: D. Perform weight-bearing exercises The nurse should instruct the client to perform weight-bearing exercises to promote bone formation and increase strength and mobility. Incorrect Answers: A. The nurse should instruct the client to increase the dietary intake of calcium, vitamin D, protein, magnesium, and vitamin K to promote bone formation. B. The nurse should instruct the client to apply heat to relieve discomfort. C. The nurse should instruct the client to increase the calcium intake to 1,200 to 1,500 mg per day.

A nurse is caring for a female client who has osteoporosis and is taking raloxifene. Which of the following findings should indicate to the nurse that the client is experiencing an adverse effect of this medication? A. Severe leg cramps B. Urinary frequency C. Jaw pain D. Sudden onset of dyspnea

Correct Answer: D. Sudden onset of dyspnea The nurse should identify that raloxifene is a selective estrogen receptor modulator (SERM), which can have estrogenic effects in some tissues and anti-estrogenic effect in other tissues. Clients who are taking raloxifene have an increased risk of thromboembolic events such as deep-vein thrombosis, pulmonary embolism, or stroke. Therefore, the nurse should notify the provider if the client is experiencing this adverse effect of raloxifene. Incorrect Answers: A. Severe leg cramps are not an adverse effect of this medication. Teriparatide is a form of parathyroid hormone (PTH) that is used to treat osteoporosis by increasing bone formation. Adverse effects of teriparatide can include arthralgias, muscle pain in the lower extremities, and headaches. B. Urinary frequency is not an adverse effect of this medication. Denosumab is a monoclonal antibody that decreases bone resorption and suppresses the development of osteoclasts in clients who have osteoporosis. Clients taking denosumab should be monitored for bladder infections. C. Jaw pain is not an adverse effect of this medication. Zoledronate is a bisphosphonate that is used to treat osteoporosis by inhibiting the action of osteoclasts and preventing bone resorption. Zoledronate can cause osteonecrosis of the jaw, which can result in localized bone death and decreased bone strength

A nurse is determining a client's risk of developing osteoporosis. The nurse should identify which of the following as risk factors for bone loss? (Select all that apply.) A. Small body frame B. Hypertension C. African-American ethnicity D. Low vitamin D intake E. Smoking

Correct Answers: A. Small body frame D. Low vitamin D intake E. Smoking Females have a higher risk of developing osteoporosis than males. Other risk factors include family history, low body mass index, and a small body frame. Consuming inadequate levels of calcium and vitamin D, smoking, and ingesting high amounts of alcohol or caffeine also increase the risk of developing osteoporosis. Incorrect Answers: B. Hypertension does not specifically contribute to osteoporosis risk. Common osteoporosis comorbidities include hyperthyroidism and diabetes mellitus. C. Caucasian and Asian ethnicities are associated with a higher risk of developing osteoporosis.

A nurse is providing teaching to a client who has gout and urolithiasis. The client asks how to prevent future uric acid stones. Which of the following suggestions should the nurse provide? (Select all that apply.) A. Take allopurinol as prescribed B. Exercise several times a week C. Limit intake of foods high in purine D. Decrease daily fluid intake E. Avoid citrus juices

Correct Answers: A. Take allopurinol as prescribed B. Exercise several times a week C. Limit intake of foods high in purine The nurse should inform the client that allopurinol is an antigout medication that reduces uric acid, which helps prevent uric acid stone formation. Immobility is a risk factor for stone formation; therefore, the client should maintain a healthy lifestyle, including regular exercise. Purine increases the risk of uric acid stone formation; organ meats, poultry, fish, red wine, and gravy are high in purine. Incorrect Answers: D. Maintaining an adequate fluid intake of 2 to 3 L per day reduces the risk of stone formation. E. Citrus juices alkalinize the urine, which helps prevent uric acid stone formation.