Ch. 46

The nurse is assessing an older client who has bony nodules on finger joints (Heberden and Bouchard nodes). What priority question would the nurse want to ask as part of the client interview? "When did your bony nodules develop?" "Are you able to independently perform ADLs?" "Are your bony nodules painful or tender?" "How do you feel about having these bony nodules?"

"Are you able to independently perform ADLs?" As a result of the client having bony nodules in his or her hands, the most important question for the nurse to ask is to determine if the client is ADL independent. The nurse would also ask the other questions, but they are not the first questions to be asked.

The nurse is planning health teaching for a client starting hydroxychloroquine for rheumatoid arthritis. What instruction would the nurse include in the teaching? "Keep this medication in the refrigerator at all times." "Expect nausea and vomiting for the first week after starting the drug." "Be aware that the drug may cause secondary types of cancer." "Have eye examinations every 6 months while on the drug."

"Have eye examinations every 6 months while on the drug." Hydroxychloroquine is an antimalarial drug with immune modulating and anti-inflammatory properties. Although side effects are usually mild, long-term use of the drug can cause vision problems. The client is taught to have an eye examination prior to starting the drug and every 6 months while on the drug to detect any visual changes.

A nurse is teaching a client newly diagnosed with osteoarthritis (OA) about drugs used to treat the disease. For which drug does the nurse plan health teaching? a. Acetaminophen b. Cyclobenzaprine hydrochloride c. Hyaluronate d. Ibuprofen

ANS: A All of these drugs may be appropriate to treat OA. However, the first-line drug is acetaminophen. Cyclobenzaprine is a muscle relaxant given to treat muscle spasms. Hyaluronate is a synthetic joint fluid implant. Ibuprofen is a nonsteroidal anti-inflammatory drug.

A client was recently diagnosed with osteoarthritis and asks the nurse which over-the-counter drug would be the best to take? What would the nurse's recommendation be? Ibuprofen Acetaminophen Gabapentin Tramadol

Acetaminophen Several major medical organizations, including the American Pain Society and OARSI committee recommend acetaminophen as the primary drug of choice.

The nurse is preparing a client for a total hip arthroplasty today. What IV antibiotic would the nurse likely administer if the client has no drug allergies? Vancomycin Clindamycin Cefazolin Penicillin

Cefazolin Cephalosporins are the drug class of choice for clients without allergies who are having a total joint arthroplasty.

The nurse is caring for a client who has a continuous femoral nerve blockade following a total knee arthroplasty. What nursing assessment does the nurse need to perform to ensure client safety? Perform focused cardiovascular and respiratory assessments. Check that the client can dorsiflex and plantar flex the foot on the operative leg. Monitor for excessive blooding and bruising during the infusion. Monitor vital signs frequently to detect early complications.

Check that the client can dorsiflex and plantar flex the foot on the operative leg. To ensure that the client is not receiving excessive anesthesia, the client should be able to dorsiflex and plantar flex the foot on the operative leg. The purpose of the continuous femoral nerve blockade is to help control postoperative pain.

The nurse assesses a client diagnosed with Sjögren syndrome. The nurse anticipates that the client will also have which symptom? Dry eyes Abdominal bloating after eating Excessive production of saliva in the mouth Intermittent episodes of diarrhea

Dry eyes Clients with Sjögren syndrome experience dry eyes (keratoconjunctivitis sicca), dry mouth, and if female, dry vagina.

The nurse is caring for a client with an inflamed, reddened, and severely painful first metatarsal joint. With what type of arthritis are these signs and symptoms associated? Rheumatoid arthritis Infectious arthritis Gouty arthritis Osteoarthritis

Gouty arthritis Clients who have gout (also called gouty arthritis) experience severe inflammation in small joints, especially the metatarsal of the great (first) toe. Gout results when urate crystals created by errors in purine metabolism deposit in small synovial joints.

The nurse is caring for a client with osteoarthritis who reports severe pain in both knees. What nonpharmacologic intervention is the most appropriate for the nurse to recommend for this client? Hot compresses or moist heating pad. Ice packs used every 3 to 4 hours during the day. Glucosamine and chondroitin combination. Massage and hypnosis.

Hot compresses or moist heating pad. Heat sources such as compresses and heating pads cause vasodilation which promotes healing in the affected joints. Ice is best for inflamed joints rather than those that are degenerative. Glucosamine and chondroitin are integrative therapies that help some clients but their effectiveness has not been validated. Massage would be painful and hypnosis may or may not be helpful, depending on the client.

The nurse is teaching a client preparing to have a total knee replacement about interventions to help prevent surgical infection. What interventions would the nurse include in this teaching? (Select all that apply.) Showering the night before and the morning of surgery with chlorhexidine Sleeping on clean linen wearing clean nightwear Avoiding sleeping with pets in the client's bed Giving antibiotics before and after surgery for at least 3 days Using nasal mupirocin for at least a week before surgery

Showering the night before and the morning of surgery with chlorhexidine Sleeping on clean linen wearing clean nightwear Avoiding sleeping with pets in the client's bed Using nasal mupirocin for at least a week before surgery All of these interventions are used to help prevent infection except for the use of long-term antibiotics. Long-term antibiotic therapy is used to treat rather than prevent postoperative infection.

The nurse is preparing to give apixaban for a client who recently had a total knee arthroplasty. What does the nurse recognize as the advantage of this drug over other anticoagulants? The client is not at risk for bleeding or bruising. The client does not need to wear sequential compression devices. The client only needs to take the drug while in the hospital. The client does not need to have labs drawn for PT or INR.

The client does not need to have labs drawn for PT or INR. Apixaban is a newer factor Xa inhibitor that helps to prevent venous thromboembolism in clients who have a total knee arthroplasty. The client taking this drug will need to continue for several weeks after surgery and is at risk for bleeding or bruising. However, the drug does not affect PT or INR, so that the client does not need to have labs drawn.

The nurse is caring for a client with osteoarthritis (OA) in the left knee. What factor does the nurse suspect is the most likely cause of this client's OA? Trauma to the joint Aging Familial history Osteoporosis

Trauma to the joint The client has OA in one knee which suggests that the client has secondary OA rather than primary disease. Secondary OA occurs as a result of joint injury or obesity.

The nurse is developing a health teaching plan for a client diagnosed with osteoarthritis (OA). The nurse includes which instruction in the teaching plan? Begin a jogging or running program. Take up knitting to slow down joint degeneration. Eat at least 2 yogurts every day. Wear supportive shoes at all times.

Wear supportive shoes at all times. Wearing supportive shoes will help prevent falls and damage to foot joints, especially metatarsal joints. Running and running promotes stress on joints and should be avoided. Repetitive stress activities such as knitting or typing should be avoided for prolonged periods. No single food can cure OA; a well-balanced diet should be recommended.

The nurse has provided health teaching for a female client starting on methotrexate (MTX) for early rheumatoid arthritis. What statement by the client indicates a need for further teaching? "I will try to avoid crowds because I could easily get an infection." "I can drink alcohol in small amounts at night to help me relax." "I will start folic acid supplements whichh can help decrease side effects." "I will use strict birth control while I am taking this drug."

"I can drink alcohol in small amounts at night to help me relax." All of these statements are correct about MTX except that the client needs to avoid all alcoholic beverages to prevent liver toxicity.

The nurse is caring for an older, alert adult client diagnosed with osteoarthritis. Which client statement indicates to the nurse that the client is using effective coping strategies? "I do not know how long my wife will be able to take care of me at home." "The bus is coming to pick me up from the senior center three times a week so I can play cards." "I am helping with the dishes and laundry, but I hurt so badly when I am doing it." "I do not know how much longer my neighbor can continue to help clean my house."

"The bus is coming to pick me up from the senior center three times a week so I can play cards." Participation in diversional activities is a way to cope with daily stressors of osteoarthritis and shows good use of available resources for support. Caregiving responsibilities can be a source of stress; the client worrying about his wife's caregiving abilities does not indicate that the client is effectively coping. Routine tasks, such as doing dishes and laundry, need to be reassigned or effective pain management should be instituted before activities are undertaken to demonstrate effective coping. Neighbors are not reliable resources for in-home needs, and asking a neighbor to help does not indicate that the client is coping effectively.

The nurse is caring for a postoperative client with total hip arthroplasty. What actions would the nurse take to prevent venous thromboembolism (VTE) postoperatively? (Select all that apply.) Ambulate the client on the day of surgery. Keep the legs slightly abducted. Elevate the client's legs. Apply pneumatic or sequential compression devices. Administer anticoagulant therapy.

Ambulate the client on the day of surgery. Apply pneumatic or sequential compression devices. Administer anticoagulant therapy. Preventive postoperative actions that help prevent VTE include pharmacology (anticoagulants), ambulation, and compression.

The nurse assesses a client with diabetes and osteoarthritis (OA) during a checkup. The nurse notes the client's blood glucose readings have been elevated. What question by the nurse is most appropriate? a. "Are you following the prescribed diabetic diet?" b. "Have you been taking glucosamine supplements?" c. "How much exercise do you really get each week?" d. "You're still taking your diabetic medication, right?"

B All of the topics are appropriate for a client whose blood glucose readings have been higher than usual. However, since this client also has OA, and glucosamine can increase blood glucose levels, the nurse would ask about its use. The other questions all have an element of nontherapeutic communication in them. Asking how much exercise the client "really" gets is or if the diet is being followed is accusatory. Asking if the client takes his or her medications "right?" is patronizing.

The nurse recognizes that a client who has persistent pain may have difficulty with pain management after a total joint arthroplasty. What collaborative interventions are needed to help the client manage postoperative pain? (Select all that apply.) Identify at-risk clients preoperatively using a comprehensive assessment. Establish trust and explain the postoperative pain management plan. Consult the pain management team if needed and available. Use multimodal and alternative pain management modalities. Plan continuing pain management after discharge.

Identify at-risk clients preoperatively using a comprehensive assessment. Establish trust and explain the postoperative pain management plan. Consult the pain management team if needed and available. Use multimodal and alternative pain management modalities. Plan continuing pain management after discharge. All of these interventions are needed to successfully manage pain for clients who have persistent (chronic) pain.