W1 Rheumatic Osteoarthritis

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? "I will take the medication in the evening." "I will drink a full glass of milk with the medication." "I will take the medication at mealtime." "I will sit upright after taking the medication."

"I will take the medication in the evening." The nurse should instruct the client to take alendronate in the morning "I will drink a full glass of milk with the medication." The nurse should instruct the client that high-calcium foods can reduce the absorption of alendronate. Alendronate can cause hypocalcemia; therefore, the client might require a calcium supplement taken at a different time of day. "I will take the medication at mealtime." The nurse should instruct the client to take alendronate at least 30 min before food. ✅"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 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? "I will wear a continuous movement machine on my knee for 24 hours a day." "I should avoid taking NSAID medications for pain after surgery." "I should wear elastic stockings on both of my legs." "I will begin exercising my legs the day after surgery."

"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 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 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 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? "Keep your arm bent at the elbow." "Use a pillow to prop your shoulder up close to your ear." "Hold your arm against the side of your body." "Position your arm with the shoulder at a 90-degree angle."

"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. ✅"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. "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 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? "You will need to apply a cold pack to the site three times a day." "Your provider might ask you to walk frequently to increase circulation to the area." "You will need to limit consumption of high-protein foods." "Your provider might prescribe a central catheter line for long-term 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. ✅"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.

74. The client with RA has nontender, movable nodules in the subcutaneous tissue over the elbows and shoulders. Which statement is the scientific rationale for the nodules? 1. The nodules indicate a rapidly progressive destruction of the affected tissue. 2. The nodules are small amounts of synovial fluid that have become crystallized. 3. The nodules are lymph nodes which have proliferated to try to fight the disease. 4. The nodules present a favorable prognosis and mean the client is better.

**1. The nodules may appear over bony promi- nences and resolve simultaneously. They appear in clients with the rheumatoid factor and are associated with rapidly progressive and destructive disease. 2. There is a proliferation of the synovial mem- brane in RA, which leads to the formation of pannus and the destruction of cartilage and bone, but synovial fluid does not crystallize to form the nodules. 3. The nodules are not lymph nodes. Lymph nodes may enlarge in the presence of disease, but they do not proliferate (multiply). 4. The nodes indicate a progression of the disease, not an improving prognosis TEST-TAKING HINT: The test taker can rule out option "3" with knowledge of anatomyor physiology. Lymph nodes do not multiply; they do form chains throughout the body. Content - Medical: Integrated Nursing Process - Diagnosis: Client Needs - Safe Effective Care Environment, Management of Care: Cognitive Level - Comprehension: Concept - Immunity.chapter 13 IMMUNE SYSTEM DISorderS

78. The nurse is planning the care for a client diagnosed with RA. Which intervention should be implemented? 1. Plan a strenuous exercise program. 2. Order a mechanical soft diet. 3. Maintain a keep-open IV. 4. Obtain an order for a sedative.

.1.The client diagnosed with RA is generally fatigued, and strenuous exercise increases the fatigue, places increased pressure on the joints, and increases pain. 2. The client should be on a balanced diet high in protein, vitamins, and iron for tissue building and repair and should not require a mechanically altered diet. 3. There is no specific reason for the client to be ordered a keep-open IV; the client can swallow needed medications. ✅4. Sleep deprivation resulting from pain is common in clients diagnosed with RA.A mild sedative can increase the client's ability to sleep, promote rest, and increase the client's tolerance of pain. TEST-TAKING HINT: The test taker should be aware of adjectives leading to an option being eliminated—for example, the word "strenuous" in option "1." Content - Medical: Integrated Nursing Process - Implementation: Client Needs - Safe Effective Care Environment, Management of Care: Cognitive Level - Application: Concept - Comfort. chapter 13 IMMUNE SYSTEM DISorderS

80. Which client problem is priority for a client diagnosed with RA? 1. Activity intolerance. 2. Fluid and electrolyte imbalance. 3. Alteration in comfort. 4. Excessive nutritional intake.

1. Activity intolerance is an appropriate client problem, but it is not priority over pain. 2. The client with RA does not experience fluid and electrolyte disturbance. ✅3. The client diagnosed with RA has chronic pain; therefore, alteration in comfort is a priority problem. 4. Clients diagnosed with RA usually experience anorexia and weight loss, unless they are tak- ing long-term steroids. TEST-TAKING HINT: The question is asking for the priority problem, and pain is priority according to Maslow's hierarchy of needs. Content - Medical: Integrated Nursing Process - Diagnosis: Client Needs - Safe Effective Care Environment, Management of Care: Cognitive Level - Analysis:Concept - Comfort. chapter 13 IMMUNE SYSTEM DISorderS

82. The nurse and a licensed practical nurse are caring for clients in a rheumatologist's office. Which task can the nurse assign to the licensed practical nurse? 1. Administer methotrexate, an antineoplastic medication, IV. 2. Assess the lung sounds of a client with RA who is coughing. 3. Demonstrate how to use clothing equipped with Velcro fasteners. 4. Discuss methods of birth control compatible with treatment medications.

1. Antineoplastic medications can be adminis- tered only by a registered nurse who has been trained in the administration and disposal of these medications. 2. Assessment cannot be assigned to a licensed practical nurse. **3. The licensed practical nurse (LPN) can demonstrate how to use adaptive clothing. 4. This is teaching requiring knowledge of medications and interactio TEST-TAKING HINT: The nurse cannot assign assessment, evaluation, or teaching or any medication requiring specialized knowledge or skills to administer safely. Content - Medical: Integrated Nursing Process - Planning: Client Needs - Safe Effective Care Environment, Management of Care: Cognitive Level - Synthesis: Concept - Nursing Roles.

77. The client diagnosed with RA has developed swan-neck fingers. Which referral is most appropriate for the client? 1. Physical therapy. 2. Occupational therapy. 3. Psychiatric counselor. 4. Home health nurse.

1. Physical therapists work with gait training and muscle strengthening. Generally, the physical therapist works on the lower half of the body. ✅*2. The occupational therapist assists the client in the use of the upper half of the body, fine motor skills, and activities of daily living. This is needed for the client with abnormal fingers. 3. A counselor can help the client discuss feelings about body image, loss of function, and role changes, but the best referral is to the occupational therapist. 4. The client may need a home health nurse eventually, but first the client should be assisted to remain as functional as possible TEST-TAKING HINT: The test taker must be aware of the roles of all the health-care team members. The counselor (option "3") canbe ruled out as a possible correct answer because swan-neck fingers are a physical problem. Content - Medical: Integrated Nursing Process - Implementation: Client Needs - Safe Effective Care Environment, Management of Care: Cognitive Level - Application: Concept - Immunity. chapter 13 IMMUNE SYSTEM DISorderS

81. The nurse is caring for clients on a medical floor. Which client should the nurse assess first? 1. The client diagnosed with RA complaining of pain at a "3" on a 1-to-10 scale. 2. The client diagnosed with SLE who has a rash across the bridge of the nose. 3. The client diagnosed with advanced RA who is receiving antineoplastic drugs IV. 4. The client diagnosed with scleroderma who has hard, waxlike skin near the eyes.

1. The client in pain should receive medication as soon as possible to keep the pain from be- coming worse, but the client is not at risk for a serious complication 2.A butterfly rash across the bridge of the nose occurs in approximately 50% of the clients diagnosed with SLE. ✅3. Antineoplastic drugs can be caustic to tis- sues; therefore, the client's IV site should be assessed. The client should be assessed for any untoward reactions to the medica- tions first. 4. Scleroderma is a disease characterized by waxlike skin covering the entire body. This is expected for this client TEST-TAKING HINT: Pain is a priority, but the test taker must determine if there is another client who could experience complications if not seen immediately. Content - Medical: Integrated Process - Assessment: Client Needs - Safe Effective Care Environment, Management of Care: Cognitive Level - Synthesis: Concept - Immunity. chapter 13 IMMune SySteM dISorderS

76. The client diagnosed with RA who has been prescribed etanercept, a tumor necrosis factor alpha inhibitor, shows marked improvement. Which instruction regarding the use of this medication should the nurse teach? 1. Explain the medication loses its efficacy after a few months. 2. Continue to have checkups and laboratory work while taking the medication. 3. Have yearly magnetic resonance imaging to follow the progress. 4. Discuss the drug is taken for three (3) weeks and then stopped for a week.

1. The drug does not lose efficacy, and clients are removed from the drug when the body cannot tolerate the side effects. **2. The drug requires close monitoring to prevent organ damage. 3. MRI scans are not used to determine the progress of RA. 4. There is no "off" period for the drug. TEST-TAKING HINT: If the test taker is not aware of the medication being discussed, option "2," the correct answer, is information which could be said of most medications. Content - Medical: Integrated Nursing Process - Planning: Client Needs - Physiological Integrity, Pharmacological and Parenteral Therapies: Cognitive Level - Synthesis: Concept - Medication. chapter 13 IMMUNE SYSTEM DISorderS

73. The client diagnosed with RA is being seen in the outpatient clinic. Which preventive care should the nurse include in the regularly scheduled clinic visits? 1. Perform joint x-rays to determine progression of the disease. 2.Send blood to the laboratory for an erythrocyte sedimentation rate. 3.Recommend the flu and pneumonia vaccines. 4. Assess the client for increasing joint involvement.

1. This is done, but it will not prevent any disease from occurring. 2. This will follow the progression of the disease of RA, but it is not preventive. **3. RA is a disease with many immunological abnormalities. The clients have increased susceptibility to infectious disease, suchas the flu or pneumonia, and, therefore, vaccines, which are preventive, should be recommended. 4. Assessing the client does not address preven- tive care. TEST-TAKING HINT: The stem requires the test taker to determine what action is pre- ventive care for the client with RA. Only option "3" addresses preventive care. Content - Medical: Integrated Nursing Process - Implementation: Client Needs - Safe Effective Care Environment, Management of Care: Cognitive Level - Application: Concept - Immunity. chapter 13 IMMUNE SYSTEM DISorderS

83. The client with early-stage RA is being discharged from the outpatient clinic. Which discharge instruction should the nurse teach regarding the use of nonsteroidal anti- inflammatory drugs (NSAIDs)? 1. Take with an over-the-counter medication for the stomach. 2. Drink a full glass of water with each pill. 3. If a dose is missed, double the medication at the next dosing time. 4. Avoid taking the NSAID on an empty stomach.

1. This is prescribing, and the nurse is not licensed to do this unless the nurse has become a nurse practitioner. 2. NSAIDs do not require a specific amount of water to be effective, unlike bulk laxatives. 3. The medication should be taken in the usual dose when the client realizes a dose has been missed. ✅*4. NSAID medications decrease prostaglandin production in the stomach, resulting in less mucus production, which creates a risk for the development of ulcers. The client should take the NSAID with food. TEST-TAKING HINT: Knowledge of medication administration is a priority for every nurse. It is especially important for the nurse to be familiar with commonly used medications such as NSAIDs, which can be purchased over the counter and may be taken by the client in addition to prescription medications. Content - Medical: Integrated Nursing Process - Planning: Client Needs - Physiological Integrity, Pharmacological and Parenteral Therapies: Cognitive Level - Synthesis: Concept - Medication.

75. The nurse is assessing a client diagnosed with RA. Which assessment findings warrant immediate intervention? 1. The client complains of joint stiffness and the knees feel warm to the touch. 2. The client has experienced one (1)-kg weight loss and is very tired .3. The client requires a heating pad applied to the hips and back to sleep. 4. The client is crying, has a flat facial affect, and refuses to speak to the nurse.

1.Joint stiffness and joints warm to the touch 2. Clients diagnosed with RA have bilateral and symmetrical stiffness, edema, tenderness, and temperature changes in the joints. Other symptoms include sensory changes, lymph node enlargement, weight loss, fatigue, and pain. A one (1)-kg weight loss and fatigue are expected. 3. The use of heat is encouraged to provide comfort for a client diagnosed with RA. **4 The client has the signs and symptoms of depression. The nurse should attempt to intervene with therapeutic conversation and discuss these findings with the HCP TEST-TAKING HINT: The test taker should not automatically assume only physiological data require immediate intervention. There will be times when a psychological need will have priority. Because options "1," "2," and "3" are all expected in a client with RA, the psy- chological need warrants intervention by the nurse. Content - Medical: Integrated Nursing Process - Assessment: Client Needs - Physiological Integrity, Reduction of Risk Potential: Cognitive Level - Synthesis: Concept - Mood. chapter 13 IMMUNE SYSTEM DISorderS

A client takes celecoxib (Celebrex) for chronic osteoarthritis in multiple joints. After a knee replacement, the health care provider has prescribed morphine sulfate for postoperative pain relief. The client also requests the celecoxib in addition to the morphine. What action by the nurse is best? a. Consult with the health care provider about administering both drugs to the client. b. Inform the client that the celecoxib will be started when he or she goes home. c. Teach the client that, since morphine is stronger, celecoxib is not needed. d. Tell the client he or she should not take both drugs at the same time.

ANS: A Despite getting an opioid analgesic for postoperative pain, the nurse should be aware that the client may be on other medications for arthritis in other joints. The nonsteroidal anti-inflammatory drug celecoxib will also help with the postoperative pain. The nurse should consult the provider about continuing the celecoxib while the client is in the hospital. The other responses are not warranted, as the client should be restarted on this medication postoperatively. DIF: Applying/Application REF: 307 KEY: Postoperative nursing| nonsteroidal anti-inflammatory drugs (NSAIDs)| musculoskeletal disorders MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

13 of 18 What response by the nurse would be most therapeutic when a client who has systemic lupus erythematosus (SLE) says, "My face has changed so much. I feel really ugly"? "I know what you mean, I feel that way sometimes too." "I bet that was hard to say. Thank you for trusting me with your feelings." "Don't worry, treatment will make everything better." "You look great. It's what is inside that counts."

Chapter 18: Care of Patients with Arthritis and Other Connective Tissue Diseases

A client is getting out of bed into the chair for the first time after an uncemented hip replacement. What action by the nurse is most important? a. Have adequate help to transfer the client. b. Provide socks so the client can slide easier. c. Tell the client full weight bearing is allowed. d. Use a footstool to elevate the clients leg.

ANS: A The client with an uncemented hip will be on toe-touch only right after surgery. The nurse should ensure there is adequate help to transfer the client while preventing falls. Slippery socks will encourage a fall. Elevating the leg greater than 90 degrees is not allowed. DIF: Applying/Application REF: 313 KEY: Joint replacement| safety| falls| musculoskeletal system MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

A client has been diagnosed with rheumatoid arthritis. The client has experienced increased fatigue and worsening physical status and is finding it difficult to maintain the role of elder in his cultural community. The elder is expected to attend social events and make community decisions. Stress seems to exacerbate the condition. What action by the nurse is best? a. Assess the clients culture more thoroughly. b. Discuss options for performing duties. c. See if the client will call a community meeting. d. Suggest the client give up the role of elder.

ANS: A The nurse needs a more thorough understanding of the clients culture, including the meaning of illness and the ramifications of the elder not being able to perform traditional duties. This must be done prior to offering any possible solutions. If the nurse does not understand the consequences of what is suggested, the client may simply be unwilling to listen or participate in problem solving. The other options may be reasonable depending on the outcome of a better cultural understanding. DIF: Applying/Application REF: 327 KEY: Rheumatoid arthritis| autoimmune disorders| coping| culture| patient-centered care| diversity MSC: Integrated Process: Caring NOT: Client Needs Category: Psychosocial Integrity

48. A man who has had gout for several years comes to the clinic with a problem with his toe. On examination, the nurse notices the presence of hard, painless nodules over the great toe; one has burst open with a chalky discharge. What is this called? a. Tophi b. Callus c. Bunion d. Plantar wart

ANS: A Tophi are collections of monosodium urate crystals resulting from chronic gout in and around the joint that cause extreme swelling and joint deformity. They appear as hard, painless nodules (tophi) over the metatarsophalangeal joint of the first toe and they sometimes burst with a chalky discharge. A callus is a hard, thickened area of skin that forms as a result of friction or pressure. A bunion is a bony bump that forms on the joint at the base of your big toe (metatarsophalangeal joint). A plantar wart is vascular papillomatous growth that occurs on the sole of the foot, commonly at the ball and has small dark spots and is painful. A callus is a hard, thickened area of skin that forms as a result of friction or pressure. A bunion is a bony bump that forms on the joint at the base of your big toe (metatarsophalangeal joint). A plantar wart is vascular papillomatous growth that occurs on the sole of the foot, commonly at the ball and has small dark spots and is painful.

A home health care nurse is visiting a client discharged home after a hip replacement. The client is still on partial weight bearing and using a walker. What safety precautions can the nurse recommend to the client? (Select all that apply.) a. Buy and install an elevated toilet seat. b. Install grab bars in the shower and by the toilet. c. Step into the bathtub with the affected leg first. d. Remove all throw rugs throughout the house. e. Use a shower chair while taking a shower.

ANS: A, B, D, E Buying and installing an elevated toilet seat, installing grab bars, removing throw rugs, and using a shower chair will all promote safety for this client. The client is still on partial weight bearing, so he or she cannot step into the bathtub leading with the operative side. Stepping into a bathtub may also require the client to bend the hip more than the allowed 90 degrees. DIF: Applying/Application REF: 315 KEY: Joint replacement| osteoarthritis| home safety| assistive devices MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

A nurse is teaching a female client with rheumatoid arthritis (RA) about taking methotrexate (MTX) (Rheumatrex) for disease control. What information does the nurse include? (Select all that apply.) a. Avoid acetaminophen in over-the-counter medications. b. It may take several weeks to become effective on pain. c. Pregnancy and breast-feeding are not affected by MTX. d. Stay away from large crowds and people who are ill. e. You may find that folic acid, a B vitamin, reduces side effects.

ANS: A, B, D, E MTX is a disease-modifying antirheumatic drug and is used as a first-line drug for RA. MTX can cause liver toxicity, so the client should be advised to avoid medications that contain acetaminophen. It may take 4 to 6 weeks for effectiveness. MTX can cause immunosuppression, so avoiding sick people and crowds is important. Folic acid helps reduce side effects for some people. Pregnancy and breast-feeding are contraindicated while on this drug. DIF: Applying/Application REF: 322 KEY: Rheumatoid arthritis| autoimmune disease| patient education| disease-modifying antirheumatic drugs (DMARDs)| acetaminophen MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

The nurse is working with clients who have connective tissue diseases. Which disorders are correctly paired with their manifestations? (Select all that apply.) a. Dry, scaly skin rash Systemic lupus erythematosus (SLE) b. Esophageal dysmotility Systemic sclerosis c. Excess uric acid excretion Gout d. Footdrop and paresthesias Osteoarthritis e. Vasculitis causing organ damage Rheumatoid arthritis

ANS: A, B, E A dry, scaly skin rash is the most frequent dermatologic manifestation of SLE. Systemic sclerosis can lead to esophageal motility problems. Vasculitis leads to organ damage in rheumatoid arthritis. Gout is caused by hyperuricemia; the production of uric acid exceeds the excretion capability of the kidneys. Footdrop and paresthesias occur in rheumatoid arthritis. DIF: Remembering/Knowledge REF: 319 KEY: Autoimmune disorders MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

A nurse is performing a musculoskeletal assessment on an older adult. What normal physiologic changes of aging does the nurse expect? Select all that apply. A.​ Muscle atrophy B.​ Slowed movement C.​ Kyphosis D.​ Arthritis E.​ Widened gait F.​ Decreased joint range-of-motion

Answer: A, B, C, D, E, F Rationale: As listed in the Older Adult Health Considerations box, all of these assessment findings are common physiologic changes associated with the aging process Chapter 44 - Assessment of the Musculoskeletal System iggy

An older client returning to the postoperative nursing unit after a hip replacement is disoriented and restless. What actions does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) a. Apply an abduction pillow to the clients legs. b. Assess the skin under the abduction pillow straps. c. Place pillows under the heels to keep them off the bed. d. Monitor cognition to determine when the client can get up. e. Take and record vital signs per unit/facility policy.

ANS: A, C, E The UAP can apply an abduction pillow, elevate the heels on a pillow, and take/record vital signs. Assessing skin is the nurses responsibility, although if the UAP notices abnormalities, he or she should report them. Determining when the client is able to get out of bed is also a nursing responsibility. DIF: Applying/Application REF: 311 KEY: Joint replacement| delegation| abduction pillow| unlicensed assistive personnel (UAP)| nursing Chapter 18: Care of Patients with Arthritis and Other Connective Tissue Diseases

An older client returning to the postoperative nursing unit after a hip replacement is disoriented and restless. What actions does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) a. Apply an abduction pillow to the clients legs. b. Assess the skin under the abduction pillow straps. c. Place pillows under the heels to keep them off the bed. d. Monitor cognition to determine when the client can get up. e. Take and record vital signs per unit/facility policy.

ANS: A, C, E The UAP can apply an abduction pillow, elevate the heels on a pillow, and take/record vital signs. Assessing skin is the nurses responsibility, although if the UAP notices abnormalities, he or she should report them. Determining when the client is able to get out of bed is also a nursing responsibility. DIF: Applying/Application REF: 311 KEY: Joint replacement| delegation| abduction pillow| unlicensed assistive personnel (UAP)| nursing assessment MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

The nurse is assessing a patient's ischial tuberosity. How should the nurse position the patient to palpate the ischial tuberosity? a. Standing b. Flexing the hip c. Flexing the knee d. Lying in the supine position

ANS: B The ischial tuberosity lies under the gluteus maximus muscle and is palpable when the hip is flexed. The other options are not correct. DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Health Promotion and Maintenance

A client is scheduled to have a hip replacement. Preoperatively, the client is found to be mildly anemic and the surgeon states the client may need a blood transfusion during or after the surgery. What action by the preoperative nurse is most important? a. Administer preoperative medications as prescribed. b. Ensure that a consent for transfusion is on the chart. c. Explain to the client how anemia affects healing. d. Teach the client about foods high in protein and iron.

ANS: B The preoperative nurse should ensure that all valid consents are on the chart, including one for blood transfusions if this may be needed. Administering preoperative medications is important for all preoperative clients and is not specific to this client. Teaching in the preoperative area should focus on immediate concerns. DIF: Applying/Application REF: 310 KEY: Joint replacement| informed consent| blood transfusions| preoperative nursing MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

An older client is scheduled to have hip replacement in 2 months and has the following laboratory values: white blood cell count: 8900/mm3, red blood cell count: 3.2/mm3, hemoglobin: 9 g/dL, hematocrit: 32%. What intervention by the nurse is most appropriate? a. Instruct the client to avoid large crowds. b. Prepare to administer epoetin alfa (Epogen). c. Teach the client about foods high in iron. d. Tell the client that all laboratory results are normal.

ANS: B This client is anemic, which needs correction prior to surgery. While eating iron-rich foods is helpful, to increase the clients red blood cells, hemoglobin, and hematocrit within 2 months, epoetin alfa is needed. This colony-stimulating factor will encourage the production of red cells. The clients white blood cell count is normal, so avoiding infection is not the priority. DIF: Applying/Application REF: 310 KEY: Joint replacement| anemia| colony-stimulating factors| nursing intervention MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

A client has rheumatoid arthritis that especially affects the hands. The client wants to finish quilting a baby blanket before the birth of her grandchild. What response by the nurse is best? a. Lets ask the provider about increasing your pain pills. b. Hold ice bags against your hands before quilting. c. Try a paraffin wax dip 20 minutes before you quilt. d. You need to stop quilting before it destroys your fingers.

ANS: C Paraffin wax dips are beneficial for decreasing pain in arthritic hands and lead to increased mobility. The nurse can suggest this comfort measure. Increasing pain pills will not help with movement. Ice has limited use unless the client has a hot or exacerbated joint. The client wants to finish her project, so the nurse should not negate its importance by telling the client it is destroying her joints. DIF: Applying/Application REF: 325 KEY: Rheumatoid arthritis| autoimmune disorders| nonpharmacologic pain management| heat MSC: Integrated Process: Caring NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort

The nurse is teaching a class on preventing osteoporosis to a group of perimenopausal women. Which of these actions is the best way to prevent or delay bone loss in this group? a. Assessing bone density annually b. Taking medications to prevent osteoporosis c. Performing physical activity, such as fast walking d. Taking 800 mg calcium and 200 IU vitamin D supplements daily

ANS: C Physical activity, such as fast walking, delays or prevents bone loss in perimenopausal women. The faster the pace of walking, the higher the preventive effect is on the risk for hip fracture. The other options are not correct. Annually assessing bone density does not prevent or delay bone loss, it just monitors it. There are no medications to prevent osteoporosis, but to treat it. Taking 800 mg calcium and 200 IU vitamin D supplements daily is not enough to meet the recommended daily doses for a perimenopausal woman. The best way to prevent or delay bone loss is exercise. DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Health Promotion and Maintenance

The nurse is examining a 2-month-old infant and notices asymmetry of the infant's gluteal folds. The nurse should assess for other signs of what disorder? a. Spina bifida b. Down syndrome c. Hip dislocation d. Fractured clavicle

ANS: C Unequal gluteal folds may accompany hip dislocation after 2 to 3 months of age, but some asymmetry may occur in healthy children. Further assessment is needed. The other responses are not correct. DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Safe and Effective Care Environment: Management of Care

A young swimmer comes to the sports clinic complaining of a very sore shoulder. He was running at the pool, slipped on some wet concrete, and tried to catch himself with his outstretched hand. He landed on his outstretched hand and has not been able to move his shoulder since. What does the nurse suspect? a. Joint effusion b. Tear of rotator cuff c. Adhesive capsulitis d. Dislocated shoulder

ANS: D Chapter 23 - Musculoskeletal System 293 A dislocated shoulder occurs with trauma involving abduction, extension, and external rotation (e.g., falling on an outstretched arm or diving into a pool. . Joint effusion is swelling from excess fluid in the joint capsule. Tear of rotator cuff typically presents in a "hunched" position and limited abduction of arm. Adhesive capsulitis (frozen shoulder) presents with stiffness; progressive limitation of motion in abduction and external rotation, and unable to reach overhead; and pain caused by the formation of fibrous tissues in the joint capsule. This patient appears to have a dislocated shoulder. DIF: Cognitive Level: Analyzing (Analysis) MSC: Client Needs: Physiological Integrity: Physiological Adaptation Chapter 23: Musculoskeletal System Jarvis: Physical Examination and Health Assessment, 8th Edition

A nurse is caring for a client with osteoarthritis receiving piroxicam (Feldene®). Which instruction is most important for the nurse to include in the medication teaching plan? 1. "Take the medication with food to decrease gastric irritation." 2. "If your pain is severe, you can take an additional dose of the medication." 3. "Lie down until the medication begins to be effective for pain control." 4. "If you feel you are lacking energy, you can safely take ginkgo for an energy boost."

ANSWER: 1 Piroxicam should be taken with food and a full glass of water to pre- vent gastric irritation and possible bleeding. Piroxicam is administered in a once-daily dose, and additional doses should not be taken. Because of the gastric irritation and possible reflux, the client should sit upright after taking the medication. Ginkgo interacts with piroxicam, increasing the risk for bleeding. ➧ Test-takingTip: Focus on the gastric irritation that occurs with many anti-inflammatory medications. Note that options 1 and 3 address gastric irritation. Eliminate one of these options. Content Area: Adult Health; Category of Health Alteration: Pharmacological and Parenteral Therapies; Integrated Processes: Communication and Documentation; Client Need: Physiological Integrity/Pharmacological and Parenteral Therapies/Medication Administration; Health Promotion and Maintenance/Principles of Teaching and Learning; Cognitive Level: Application Reference: Abrams, A., Lammon, C., & Pennington, S. (2007). Clinical Drug Therapy: Rationales for Nursing Practice (8th ed., pp. 120-121). Philadelphia: Lippincott Williams & Wilkins.

A client is diagnosed with degenerative joint dis- ease of the left knee, which is to be treated conserva- tively. A nurse should include which information when planning teaching for the client? SELECT ALL THAT APPLY. 1. Begin a progressive walking program 2. Modify diet for weight reduction 3. Apply cold or heat to the knee joint 4. Obtain a prescription for narcotic analgesics for pain control 5. Avoid prolonged standing, kneeling, squatting, and stair climbing 6. Perform vigorous activities daily, such as rapid flexion and extension of the knee

ANSWER: 1, 2, 3, 5 Progressive walking strengthens bone and muscles and helps reduce obesity. Walking should be for a duration that is well tolerated initially and then walking is gradually increased to a duration of 30-60 minutes 5 to 7 days per week. Weight reduction decreases stress on the joints. Cold will reduce swelling and inflammation; heat increases circulation to the area and increases comfort. Avoiding prolonged standing, kneel- ing, squatting, and stair climbing will protect the knee joint. First-line medications include acetaminophen (Tylenol®) or, if not effective, a nons- teroidal anti-inflammatory drug (NSAID). Vigorous activities that produce prolonged pain and inflammation should be avoided because these stress the joint. ➧ Test-taking Tip: Focus on initial measures to protect the knee joint, reduce pain, and increase activity tolerance. Content Area: Adult Health; Category of Health Alteration: Musculoskeletal Management; Integrated Processes: Nursing Process Planning; Client Need: Physiological Integrity/Physiological Adaptation/ Illness Management; Cognitive Level: Application Reference: Smeltzer, S., Bare, B., Hinkle, J., & Cheever, K. (2008). Brunner & Suddarth's Textbook of Medical-Surgical Nursing (11th ed., pp. 1914-1917). Philadelphia: Lippincott Williams & Wilkins. EBP Reference: American Academy of Orthopaedic Surgeons (AAOS). (2008). Treatment of osteoarthritis of the knee (non-arthroplasty). Rosemont (IL): AAOS. Available at: www.guideline.gov/summary/ summary.aspx?doc_id=14279&nbr=7155

3. An older client with osteoarthritis is taking celecoxib (Celebrex®). After reviewing the client's laboratory values for the past 3 months, what should be a clinic nurse's priority when assessing the client? Serum Laboratory Test BUN Creatinine 6 Months Ago 13 mg/dL 0.8 mg/dL 3 Months Ago 19 mg/dL 1.2 mg/dL Today 28 mg/dL 1.8 mg/dL 1. Review urinalysis results 2. Measure the client's blood pressure 3. Ask the client if there has been any weight gain 4. Auscultate the client's heart sounds

ANSWER: 2 Adverse effects of long-term use of Cox-2 inhibitors include renal impairment, which can be manifested by edema and elevated blood pressure. The progressive elevation of the serum creatinine and blood urea nitrogen suggest renal impairment. The urinalysis provides additional information, but is not the priority. Weight measurement and auscultation of the heart are part of normal health assessment. ➧ Test-taking Tip: Note the key word "priority." Apply knowledge of the adverse effects of celecoxib to answer this question. Content Area: Management of Care; Category of Health Alteration: Prioritization and Delegation; Integrated Processes: Nursing Process Assessment; Client Need: Physiological Integrity/Pharmacological and Parenteral Therapies/Adverse Effects/Contraindications; Cognitive Level: Analysis Reference: Abrams, A., Lammon, C., & Pennington, S. (2007). Clinical Drug Therapy: Rationales for Nursing Practice (8th ed., p. 108). Philadelphia: Lippincott Williams & Wilkins.

A 62-year-old female client is attending a community health fair. A health fair nurse recommends that the client make an appointment with a physician and ask that a DEXA (dual-energy x-ray absorptiometry) scan be done to evaluate for osteoporosis because the client has many risk factors. Which risk factor likely influenced the health fair nurse's decision to recom- mend a DEXA scan? 1. Diabetes mellitus 2. Postmenopausal 3. Overweight 4. African American

ANSWER: 2 Major risk factors for osteoporosis include increased age, female sex, White or Asian race, family history of osteoporosis, and a thin body structure. Since osteoporosis is the most common metabolic disease, affecting 50% of women during their lifetime, it is important for women to be screened and begin appropriate treatment, if needed. Diabetes mellitus and being overweight are not risk factors for osteoporo- sis. Being overweight can contribute to the development of osteoarthritis. ➧Test-takingTip:Focusonwhatthequestionisasking:risk factors of osteoporosis. Content Area: Adult Health; Category of Health Alteration: Older Client Needs; Integrated Processes: Nursing Process Evaluation; Client Need: Health Promotion and Maintenance/Health Screening; Cognitive Level: Application Reference: Tabloski, P. (2006). Gerontological Nursing (p. 557). Upper Saddle River, NJ: Pearson/Prentice Hall.

1.The nurse is preparing to teach a client about how to promote musculoskeletal health. Which statements will the nurse include in the teaching plan? Select all that apply. A. "If you smoke, you need a smoking cessation plan." B. "Avoid drinking excessive alcohol." C. "Be sure to take in enough calcium and Vitamin D." D. "Avoid high-risk activities that could cause an accident." E. "Include weight-bearing exercise like walking on a regular basis."

Answers: A, B, C, D, E Rationales: All of these choices are correct because they can help promote musculoskeletal health. Chapter 44 - Assessment of the Musculoskeletal System iggy

Cyclosporine (Sandimmune®) and methotrexate (Rheumatrex®) are prescribed for a client with severe rheumatoid arthritis. Which points should a nurse address when teaching the client about these medications? SELECT ALL THAT APPLY. 1. Drinking grapefruit juice is best because the medications' effects are enhanced. 2. Keep well hydrated to maximize the therapeutic effects of methotrexate. 3. Avoid use of St. John's wort, echinacea, and melatonin, as these may interfere with immunosuppression. 4. These medications are administered weekly by subcutaneous injection. 5. Both methotrexate and cyclosporine suppress the immune system.

ANSWER: 2, 3, 5 Adequate hydration minimizes the risk of adverse effects. St. John's wort decreases cyclosporine levels. Echinacea and melatonin interact with cyclosporine to alter immunosuppression. Methotrexate and cy- closporine both have immunosuppressive effects. Grapefruit juice should be avoided because it can increase the concentration of cyclosporine. Methotrexate and cyclosporine can be taken orally instead of by injection. It is incorrect that both medications are taken weekly. Only methotrexate is taken weekly, whereas cyclosporine is usually taken twice daily. ➧ Test-taking Tip: Read each option carefully and apply knowledge of the immunosuppressant medications to answer this question. Content Area: Adult Health; Category of Health Alteration: Pharmacological and Parenteral Therapies; Integrated Processes: Teaching and Learning; Client Need: Physiological Integrity/ Pharmacological and Parenteral Therapies/Pharmacological Interactions; Cognitive Level: Analysis References: Aschenbrenner, D., & Venable, S. (2009). Drug Therapy in Nursing (3rd ed., pp. 432-436). Philadelphia: Lippincott Williams & Wilkins; Wilson, B., Shannon, M., Shields, K., & Stang, C. (2008). Prentice Hall Nurse's Drug Guide 2008 (pp. 397-400, 967-970). Upper Saddle River, NJ: Pearson Education.

To which client should a nurse plan to provide teaching about genetic resources? 1. Client who had an ankle fracture secondary to a boating accident 2. Client who had a ganglion removed from the dorsum of the wrist 3. Client who had a surgical repair of a fracture due to osteoporosis 4. Client who had a total knee replacement due to degenerative joint disease

ANSWER: 3 Genetic factors influence the development of osteoporosis. There is no known genetic link for a ganglion, degenerative joint disease, or accidental fractures (except those due to osteoporosis). ➧ Test-taking Tip: Use the process of elimination to narrow the options to 3 and 4 because these options include secondary causes within the body. Of these two options, eliminate option 4, recalling that degenerative joint disease is caused by osteoarthritis. Content Area: Adult Health; Category of Health Alteration: Musculoskeletal Management; Integrated Processes: Teaching and Learning; Client Need: Safe and Effective Care Environment/Management of Care/Continuity of Care; Cognitive Level: Analysis Reference: Smeltzer, S., Bare, B., Hinkle, J., & Cheever, K. (2008). Brunner & Suddarth's Textbook of Medical-Surgical Nursing (11th ed., p. 2345). Philadelphia: Lippincott Williams & Wilkins

A client diagnosed with osteoarthritis, tells a clinic nurse about the inability to ambulate and staying on bedrest because of hip stiffness. In addition to teaching the client measures to reduce joint stiffness, which referral for the client should the nurse plan to discuss with the health-care provider? 1. Psychiatrist 2. Social worker 3. Physical therapist 4. Arthritis Foundation

ANSWER: 3 The physical therapist can assist the client in adopting self-management strategies and teach isometric, postural, and aerobic exercises that pre- vent joint overuse. A psychiatrist would assist the client in dealing with the mental health aspects related to the disease, such as ineffective coping, loss, or anger. There is no evidence that the client has mental health issues. The social worker would address issues such as finances, home assistance, place- ment, or acquiring assistive devices. The Arthritis Foundation provides a wealth of information to the client, but a referral is not necessary. The client can initiate the contact. ➧ Test-taking Tip: Focus on the issue, joint stiffness, and the health-care specialty that can best assist the client. Content Area: Adult Health; Category of Health Alteration: Musculoskeletal Management; Integrated Processes: Nursing Process Planning; Client Need: Safe and Effective Care Environment/ Management of Care/Referrals; Cognitive Level: Application

18 of 18 Which assessment findings will the nurse expect to see in a client who is suspected to have systemic lupus erythematosus (SLE)? (Select all that apply.) Select all that apply. Anemia Joint pain and swelling Hair loss Fever Fatigue Facial redness

Anemia Joint pain and swelling Hair loss Fever Fatigue Facial redness Each of these assessment findings has been associated with systemic lupus erythematosus (SLE).

12 of 18 Which statement by a client who has systemic lupus erythematosus (SLE) indicates to the nurse that more education about the disorder and its management is needed? "My friend and I are going to start walking 2 miles daily." "Taking my temperature every day can help me recognize when a flair is starting." "If I still have a lot of pain after taking an NSAID, I can also take acetaminophen." "At the first sign of a flare, I will begin taking my medication again."

Chapter 18: Care of Patients with Arthritis and Other Connective Tissue Diseases

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? Bulging in the area over the surgical incision Shortening of the right leg Sensation of warmth over the surgical incision Pallor following elevation of the right leg

Bulging in the area over the surgical incision The nurse should not expect visible bulging following dislocation of the prosthesis. ✅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. 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.

14 of 18 What is the pathophysiologic basis for Lyme disease progression to stage III? Changing the organism's surface antigens leading to chronic inflammation and elevated cytokine levels Failure of the immune system to recognize the causative organism as non-self, allowing it to become a systemic infection Triggering of antibodies against infected cells that lead to autoimmune disease The special ability of Borrelia burgdorferi to burrow deeply into joint, cardiac, and neurons causing direct damage to these tissues

Chapter 18: Care of Patients with Arthritis and Other Connective Tissue Diseases

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? Colchicine Naproxen Aspirin Prednisone

Colchicine 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. ✅Aspirin Aspirin can decrease the effectiveness of probenecid. The nurse should caution the client to avoid interaction between probenecid and salicylate medications. Prednisone Prednisone is a glucocorticoid medication used to treat gout and is not known to interact with probenecid.

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

Decreased intake of phosphate-containing foods The nurse should identify increased intake of phosphate-containing foods, such as carbonated beverages, as a risk factor for osteoporosis. Spending several hours in the sun daily The nurse should identify lack of time outdoors in sunlight as a risk factor for osteoporosis. Increased estrogen levels The nurse should identify decreased estrogen or testosterone as a risk factor for osteoporosis. ✅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 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? Sensation of heat on the surface of the cast Paresthesias of the extremity Pruritus of the extremity Musty odor noted from cast materials

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. ✅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. 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.

Which diagnostic test requires the nurse to know whether the client is allergic to iodine-based contrast? Arthroscopy Electromyography (EMG) Computed tomography (CT) Tomography

✅Computed tomography (CT) A CT scan creates three-dimensional images and may be done with iodine-based contrast. Arthroscopy, EMG, and tomography do not use iodine-based contrast. Chapter 44 - Assessment of the Musculoskeletal System iggy

2 of 11 A client is scheduled to have a bone scan for a suspected bone tumor. What statement by the nurse is correct about the procedure for this test? "It sees sound waves to produce an image of the skeleton." "It requires an injected radioactive material to view entire skeleton." 'It requires an injected iodine-based contrast medium to view the bone." "It relies on magnetic waves to help produce the image of the bone."

✅"It requires an injected radioactive material to view entire skeleton." A bone scan produces images of the entire skeleton through the use of a radioactive material that is used prior to imaging. Chapter 44 - Assessment of the Musculoskeletal System iggy

2 of 18 Which type of hypersensitivity reaction will the nurse suspect in a client who develops as circular rash on the skin underneath a new necklace worn for 3 days? Type IV Type I Type II Type III

✅ Type IV A type IV delayed hypersensitivity reaction occurs when sensitized T-cells respond to an antigen by releasing chemical mediators and triggering macrophages. This reaction causes a rash as seen in a metal allergy exposure. A type I reaction occurs rapidly after exposure and is mediated by immunoglobulin E (IgE). Type II reactions occur when the body makes autoantibodies directed against self-cells and attack those cells. Type III reactions occur when an abundance of immune complexes are made and they get stuck in small vessels causing inflammation Chapter 18: Care of Patients with Arthritis and Other Connective Tissue Diseases

6. The nurse is working with clients who have connective tissue diseases. Which disorders are correctly paired with their manifestations? (Select all that apply.) a. Dry, scaly skin rash Systemic lupus erythematosus (SLE) b. Esophageal dysmotility Systemic sclerosis c. Excess uric acid excretion Gout d. Footdrop and paresthesias Osteoarthritis e. Vasculitis causing organ damage Rheumatoid arthritis

✅ ANS: A, B, E A dry, scaly skin rash is the most frequent dermatologic manifestation of SLE. Systemic sclerosis can lead to esophageal motility problems. Vasculitis leads to organ damage in rheumatoid arthritis. Gout is caused by hyperuricemia; the production of uric acid exceeds the excretion capability of the kidneys. Footdrop and paresthesias occur in rheumatoid arthritis. DIF: Remembering/Knowledge REF: 319 KEY: Autoimmune disorders MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation Chapter 18: Care of Patients with Arthritis and Other Connective Tissue Diseases

7 of 11 A client is scheduled to undergo closed magnetic resonance imaging (MRI) without contrast medium. Which information does the nurse give to the client before the test? "Do not eat or drink for 8 hours before the test." "It will be important to lie still in a reclined position for 20 minutes." "You can have the MRI if you have an internal pacemaker." "All jewelry and clothing with zippers or metal fasteners must be removed."

✅"All jewelry and clothing with zippers or metal fasteners must be removed." The nurse tells the client that all clothing with zippers or metal fasteners and all jewelry must be removed before undergoing MRI. The client having a closed MRI will lie still in a supine position for 45 to 60 minutes, not 20 minutes, and may require sedation. It is not necessary for the client to be NPO before an MRI. The client cannot undergo MRI when an internal pacemaker or any other metal object is present in the body. Chapter 44 - Assessment of the Musculoskeletal System iggy

4 of 16 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?" "How do you feel about having these bony nodules?" "Are you able to independently perform ADLs?" "Are your bony nodules painful or tender?

✅"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. Chapter 46 - Concepts of Care for Patients With Arthritis and Total Joint Arthroplasty

8 of 11 The client asks what tool the physical therapist (PT) used to measure joint range of motion (ROM)? How would the nurse respond? "Goniometer" "Reflex hammer" "Tonometer" "Doppler device"

✅"Goniometer" A goniometer provides an exact measurement of flexion and extension or joint ROM. A Doppler device is used to check and find pulses. A reflex hammer is used to test and elicit reflexes and is used in neurologic examinations. A tonometer is used to measure tension or pressure in the eye. Chapter 44 - Assessment of the Musculoskeletal System iggy

13 of 16 The nurse is planning health teaching for a client starting hydroxychloroquine for rheumatoid arthritis. What instruction would the nurse include in the teaching? "Be aware that the drug may cause secondary types of cancer." "Expect nausea and vomiting for the first week after starting the drug." "Have eye examinations every 6 months while on the drug." "Keep this medication in the refrigerator at all times."

✅"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. Chapter 46 - Concepts of Care for Patients With Arthritis and Total Joint Arthroplasty

12 of 16 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 will start folic acid supplements whichh can help decrease side effects." "I can drink alcohol in small amounts at night to help me relax." "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. Chapter 46 - Concepts of Care for Patients With Arthritis and Total Joint Arthroplasty

1 of 11 A client is scheduled for magnetic resonance arthrography of the right knee to determine ligament damage. Which statement by the client indicates a need for further teaching? "I can take ibuprofen to help with any discomfort after the procedure." "I will need to use ice for a day or two after the procedure to prevent swelling." "My knee will be numbed before the needle is inserted into my joint." "I'll only be in the hospital overnight to get the procedure done."

✅"I'll only be in the hospital overnight to get the procedure done." This test does not require hospitalization. The client will receive local anesthesia where a needle will be inserted to inject a contract medium. After the test is performed, the client would want to use ice and NSAIDs or acetaminophen for discomfort and swelling. Chapter 44 - Assessment of the Musculoskeletal System iggy

6 of 18 Which client statement about the use and care of an epinephrine autoinjector for a peanut allergy indicates to the nurse that more teaching is needed? "If I inject myself, I will still go immediately to the emergency department." "When needed, I can inject the drug right through my clothing." "My wife and I will both practice putting the device together." "If I keep the injector in the refrigerator, the drug will not expire as quickly."

✅"If I keep the injector in the refrigerator, the drug will not expire as quickly." Although it is true that the drug may not deteriorate as quickly if refrigerated, the client needs to have the drug with him or her at all times to use as soon as symptoms of anaphylaxis occur in order to prevent death. All other statements for the use and care of an epinephrine autoinjector are correct

2 of 16 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 Osteoporosis Familial history

✅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 Chapter 46 - Concepts of Care for Patients With Arthritis and Total Joint Arthroplasty

10 of 18 What is the nurse's best response to a client newly diagnosed with systemic lupus erythematosus (SLE) who asks why nicotine use, especially cigarette smoking or vaping, should be avoided? "Nicotine reduces blood flow to your organs and increases the risk for permanent damage." "Using nicotine in any form reduces the effectiveness of drug therapy for lupus." "Nicotine promotes muscle cell loss, increases joint inflammation, and reduces functional mobility." "Smoking or vaping increases your risk for lung cancer development."

✅"Nicotine reduces blood flow to your organs and increases the risk for permanent damage." Nicotine in any form constricts blood vessels and reduces perfusion. Perfusion is already reduced by the vasculitis that is part of the disease. Thus, use of nicotine greatly increases the risk for necrosis of many tissues and organs. Although smoking or vaping do increase the risk for lung cancer, their effects on blood vessels are a greater issue for the client with SLE. Nicotine neither reduces the effectiveness of drug therapy nor promotes muscle cell loss.

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? "Osteoarthritis is caused by autoimmune processes." "Osteoarthritis leads to a decreased erythrocyte sedimentation rate." "Osteoarthritis affects other organ systems." "Osteoarthritis can impair a joint on a single side of the body."

✅"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.

7 of 16 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." "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."

✅"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. Chapter 46 - Concepts of Care for Patients With Arthritis and Total Joint Arthroplasty

1 of 18 What is the nurse's best response to a client who had a severe allergic reaction to shrimp states, "I have had shrimp once before and did not have a reaction. Why is this happening now?" "Allergies are tricky, and many reasons for responses are not known." "It is most likely that you didn't eat enough shrimp the first time to cause a reaction." "The first time your body recognized the shrimp as an allergen, and the second time it reacted to it." "This means you may be allergic to something else and not to shrimp."

✅"The first time your body recognized the shrimp as an allergen, and the second time it reacted to it." Type I reactions have two parts. During the first exposure, the client makes antigen-specific IgE, and becomes sensitized to the allergen. When the sensitized client is re-exposed to the allergen, a more severe reaction occurs. To point out the amount of shrimp eaten is not helpful and could make the client believe that eating only a small amount of shrimp would not cause a reaction. The same is true for option C. Stating that allergies "are tricky" does not help to inform or educate the client about what he or she should do to prevent harm. This response may make the client afraid of everything in his or her environment Chapter 18: Care of Patients with Arthritis and Other Connective Tissue Diseases

A 70-year old woman is admitted to the hospital with suspected streptococcal pneumonia. She continues to have an occasional cough, mild dyspnea, and a fever over 100 degrees F (37.8 degrees C) after a week of treatment with amoxicillin at home. The hospitalist prescribes IV levofloxacin 750 mg daily. The admitting nurse documents the following history and physical assessment data: --Has a 25-year history of rheumatoid arthritis (RA) and osteoarthritis --Was diagnosed with diabetes mellitus type 2 last year which is controlled by diet --Has a history of atrial fibrillation --Is retired and lives along in a senior housing apartment --Volunteers twice a week in the local library --Current medications include: ​- Etanercept 50 mg subcutaneously each week (self-administered) for RA ​- Leflunomide 10 mg orally each day for RA ​- Clopidogrel 75 mg orally each day for atrial fibrillation ​- Acetaminophen 500 mg orally as needed twice a day for OA pain --Has two children who live locally --Is able to perform ADLs independently although she has ulnar deviation and finger deformities in both hands --Uses a cane when not at home --Drives short distances to the grocery store and bank --Is alert and oriented --Reports occasional constipation --Reports current joint pain level is a 5 on a 0-10 pain scale; most painful joints are her feet and knees (states that her usual pain level is a 1-2 prior to hospital admission) --Reports occasional paresthesias in both feet --Has 1+ nonpitting edema in both feet --Current oral temperature = 100.8 degrees F (38.2 degrees C) --Current apical pulse = 82 --Resting respiratory rate = 32 breaths/minutes --Current blood pressure = 138/88 --Admitting WBC = 15,500/mm3 1.​What assessment information in this client situation is the most important and immediate concern for the nurse? (Hint: Identify the relevant information first to determine what is most important.) 2.​What client conditions are consistent with the most relevant information? (Hint: Think about priority collaborative problems that support and contradict the information presented in this situation.) 3.​Which possibilities or explanations are most likely to be present in this client situation? Which possibilities or explanations are the most serious? (Hint: Consider all possibilities and determine their urgency and risk for this client.) 4.​What actions would most likely achieve the desired outcomes for this client? Which actions should be avoided or are potentially harmful? (Hint: Determine the desired outcomes first to decide which actions are appropriate and those that should be avoided.) 5.​Which actions are the most appropriate and how should they be implemented? In what priority order should they be implemented? (Hint: Consider health teaching, documentation, requested health care provider orders or prescriptions, nursing skills, collaboration with or referral to health team members, etc.) 6.​What client assessment would indicate that the nurse's actions were effective? (Hint: Think about signs that would indicate an improvement, decline, or unchanged client condition.)

✅1. --Is over 65 years of age --Has a 25-year history of rheumatoid arthritis (RA) and osteoarthritis --Has a history of atrial fibrillation and recent diagnosis of diabetes mellitus type 2 --Current medications include: ​​- Etanercept 50 mg subcutaneously each week (self-administered) for RA ​​- Leflunomide 10 mg orally each day for RA ​​- Clopidogrel 75 mg orally each day for atrial fibrillation ​​- Acetaminophen 500 mg orally as needed twice a day for OA pain --Is able to perform ADLs independently although she has ulnar deviation and finger deformities in both hands --Uses a cane when not at home --Reports current joint pain level is a 5 on a 0-10 pain scale; most painful joints are her feet and knees --Is alert and oriented --Current oral temperature = 100.8 degrees F (38.2 degrees C) --Resting respiratory rate = 32 breaths/minutes (has had mild dyspnea) --Reports occasional cough --Admitting WBC = 15,500/mm3 ✅2. --Mild dyspnea, cough, and tachypnea --Fever --Increased WBC count --Persistent pain in lower extremities --Impaired mobility --Risk for additional infection --Risk for bleeding --Risk for increased healing time ✅3. --Dyspnea, cough, and tachypnea likely due to unresolved pneumonia --Fever and increased WBC count likely due to infection (pneumonia) --Infection may be the result of client taking enteracept (biologic response modifier) and older age (over 65 years) --Joint pain in lower extremities due to RA and/or OA --Impaired mobility requiring a cane to ambulate likely due to RA and/or OA --Risk for bleeding due to client taking clopidogrel (anti-platelet drug) --Risk for increased healing time due to drug therapy for RA which suppresses immunity and diabetes mellitus ✅4. --Need to improve ease of breathing and minimize cough --Need to manage joint pain --Need to resolve infection and prevent additional infection --Need to manage RA to prevent disease exacerbation --Need to prevent falling ✅5 --Keep client in sitting position to facilitate breathing. --Start oxygen via nasal cannula at 2-3 L/minute. --Place client on fall precautions, including staff assistance when client is out of bed. --Place client on bleeding precautions due to anti-platelet medication. --Use meticulous infection control measures to prevent acquiring additional infection. --Request continuation of the client's current drug regimen to prevent RA exacerbation and manage joint pain. --Monitor vital signs every 4 hours. --Continue to monitor WBC count during client's hospital stay. ✅6 --Client will not experience dyspnea. --Client will not experience a fall. --Client will not experience any signs of bleeding. --Systemic infection will resolve as evidenced by normal WBC, normal body temperature, and normal respiratory rate without cough --Client will not acquire additional infection while hospitalized. --Persistent pain will be controlled as evidenced by client report of pain as 2 on a 0-10 pain scale. Chapter 46 - Concepts of Care for Patients With Arthritis and Total Joint Arthroplasty

A 45-year-old client is an inpatient with type I diabetes who has just started receiving the antibiotic ceftriaxone intravenously for a facial abscess that is close to her right eye. Her other health problems include moderate hypertension well controlled with lisinopril and osteoarthritis of the left knee for which she takes meloxicam daily. She has documented allergies to peanuts, other tree nuts, and penicillin. She is married, with two children, and is a full-time third grade teacher. She puts on her call light to report that she feels dizzy and is having shortness of breath. When the nurse reached the bed-side, the following observations are noted: • oxygen saturation by pulse oximetry is 86% • all the food on the lunch tray has been eaten • there is normal saline hanging and 125 mL of the 250 mL total of the ceftriaxone remains in the piggy-back bag • she received her premeal insulin dose 45 minutes ago • vital sign assessment reveals a respiratory rate of 34, heart rate of 110, and BP of 94/50 • can talk but is having a hard time finding words 1.​What assessment information in this client situation is the most important and immediate concern for the nurse? (Hint: Identify the relevant information first to determine what is most important.) 2.​What client conditions are consistent with the most relevant information? (Hint: Think about priority collaborative problems that support and contradict the information presented in this situation.) 3.​Which possibilities or explanations are most likely to be present in this client situation? Which possibilities or explanations are the most serious? (Hint: Consider all possibilities and determine their urgency and risk for this client.) 4.​What actions would most likely achieve the desired outcomes for this client? Which actions should be avoided or are potentially harmful? (Hint: Determine the desired outcomes first to decide which interventions are appropriate and those that should be avoided.) 5.​Which actions are the most appropriate and how should they be implemented? In what priority order should they be implemented? (Hint: Consider health teaching, documentation, requested health care provider orders or prescriptions, nursing skills, collaboration with or referral to health team members, etc.) 6.​What client assessment would indicate that the nurse's actions were effective? (Hint: Think about signs that would indicate an improvement, decline, or unchanged client condition.)

✅1. •​Reports shortness of breath •​Reports dizziness •​Oxygen saturation of 84% •​Rapid heart and respiratory rates •​Has type 1 diabetes •​Received insulin 45 minutes ago •​Has known drug allergy •​Is receiving a drug intravenously •​Has long-standing hypertension ✅2. •​Hypoxia with poor gas exchange and shortness of breath •​Lower than normal blood pressure •​Cognition is decreasing ✅3 •​Changes in vital signs could be due to anaphylaxis or serious hypoglycemia •​Anaphylaxis is more likely because she has a known penicillin allergy and is receiving ceftriaxone (which is chemically very similar to penicillin and most people with a penicillin allergy are also allergic to the cephalosporins) •​Serious hypoglycemia is less likely even though she received insulin 45 minutes ago because she has eaten her lunch ✅4 •​The priority outcomes are to stop anaphylaxis (and shock) and restore gas exchange •​Testing of the client's blood glucose level is not critical at this time and the nurse should not take the time needed to perform this action •​Client needs appropriate drug therapy immediately •​Client needs oxygen therapy •​Client needs IV fluids to support perfusion ✅5 •​Stop the infusion of ceftriaxone and clear the main IV line •​Administer 0.3 ml of epinephrine (1:1000 solution) IM or subcutaneously now •​Have a coworker call the Rapid Response Team •​Apply oxygen •​Increase flow rate of normal saline •​If no improvement in oxygen saturation or BP in 5 minutes, repeat the epinephrine dose ✅6 •​Client's oxygen saturation is 90% or higher •​Client's blood pressure remains the same or is higher •​Client remains conscious and is more alert •​Client reports less or no shortness of breath Chapter 18: Care of Patients with Arthritis and Other Connective Tissue Diseases

79. The 20-year-old female client diagnosed with advanced unremitting RA is being admitted to receive a regimen of immunosuppressive medications. Which question should the nurse ask during the admission process regarding the medications? 1. "Are you sexually active, and, if so, are you using birth control?" 2. "Have you discussed taking these drugs with your parents?" 3. "Which arm do you prefer to have an IV in for four (4) days?" 4. "Have you signed an informed consent for investigational drugs?"

✅1. Immunosuppressive medications are considered class C drugs and should not be taken while pregnant. These drugs are teratogenic and carcinogenic, and the client is only 20 years old. 2. Any individual older than age 18 years is con- sidered an adult and does not need to discuss treatment with her parents unless she chooses to do so. 3. The medications can be administered on an outpatient basis, but if an inpatient has in- travenous therapy, then IV sites are changed every 72 hours and there is no guarantee an IV will last for four (4) days. 4. These are not investigational drugs and are standard therapy approved by the American College of Rheumatology and the Food and Drug Administration. TEST-TAKING HINT: The age of the client and the fact the client is female could give the test taker an idea of the correct answer. This is a client in the childbearing years. Content - Medical: Integrated Nursing Process - Assessment: Client Needs - Safe Effective Care Environment, Management of Care: Cognitive Level - Analysis: Concept - Medication. chapter 13 IMMUNE SYSTEM DISorderS

84. The nurse is preparing to administer morning medications. Which medication should the nurse administer first? 1. The pain medication to a client diagnosed with RA. 2. The diuretic medication to a client diagnosed with SLE. 3. The steroid to a client diagnosed with polymyositis .4. The appetite stimulant to a client diagnosed with OA.

✅1. Pain medication is important and should be given before the client's pain becomes worse. 2. Unless the client is in a crisis, such as pulmo- nary edema, this medication can wait. 3. Steroids do not have precedent over pain medication and should be administered with food. 4. Clients diagnosed with OA are usually overweight and do not require appetite stimulants. The nurse should question this medication before administering the medication. TEST-TAKING HINT: When determining priorities, the test taker must employ some criteria to use as a guideline. According to Maslow, pain is a priority. Content - Medical: Integrated Nursing Process - Implementation: Client Needs - Safe Effective Care Environment, Management of Care: Cognitive Level - Application: Concept - Medication.

9 of 11 The nurse is using a common scale to grade a client's muscle strength. The client is able to complete range of motion (ROM) only with gravity eliminated. Which grade does the nurse document in this client's record? 0 3 1 2

✅2 The nurse documents a grade of two (2) for this client because it indicates poor muscle strength. The client can complete ROM only with gravity eliminated. Grade zero (0) indicates no evidence of muscle contractility. Grade one (1) indicates trace muscle strength and shows that the client has no joint motion and slight evidence of muscle contractility. Grade three (3) indicates fair muscle strength, where the client can complete ROM against gravity Chapter 44 - Assessment of the Musculoskeletal System iggy

7 of 18 Which of the drugs or supplements taken daily taken by a client who is newly diagnosed with drug-induced systemic lupus erythematosus (SLE) does the nurse suspect is most likely to have caused this problem? Vitamin D Lisonopril Aspirin Hydralazine

✅A 33-year-old African-American woman whose mother has psoriasis. SLE is an autoimmune disorder that is much more common in women than in men and has a genetic predisposition related to tissue type. A client with SLE is very likely to have another close relative who also has an autoimmune disorder, such as psoriasis (myocardial infarction, type 2 diabetes mellitus, and thrombotic stroke are not autoimmune disorders). In addition, the incidence of SLE is about eight times greater for African-American women than for white women.

3 of 18 For which hypersensitivity situation will the nurse prepare a client for management with plasmapheresis? A 35 year old with drug-induced hemolytic anemia A 30 year old with poison ivy lesions on 60% of the body A 25 year old with penicillin-induced anaphylaxis A 40 year old with angioedema and tongue swelling

✅A 35 year old with drug-induced hemolytic anemia Drug-induced hemolytic anemia is a type II hypersensitivity reaction in which the body makes autoantibodies directed against red blood cells that have foreign proteins from the drug attached to them. In this type of reaction, the autoantibody binds to red blood cells, forming immune complexes that destroy red blood cells along with the attached protein. Management starts with discontinuing the offending drug and, performing plasmapheresis (filtration of the plasma to remove specific substances) to remove the formed autoantibodies. Plasmapheresis is not beneficial with other types of hypersensitivity reactions. Chapter 18: Care of Patients with Arthritis and Other Connective Tissue Diseases

During an examination, the nurse asks a patient to bend forward from the waist and notices that the patient has lateral tilting. When his leg is raised straight up, the patient states pain going down his buttock into his leg. What does the nurse suspect? a. Scoliosis b. Meniscus tear c. Herniated nucleus pulposus d. Spasm of paravertebral muscles

✅ANS: C Lateral tilting and sciatic pain with straight leg raising are findings that occur with a herniated nucleus pulposus. The other options are not correct. DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Physiological Integrity: Physiological Adaptation Chapter 23: Musculoskeletal System Jarvis: Physical Examination and Health Assessment, 8th Edition

A 40-year-old man has come into the clinic reporting extreme pain in his toes. The nurse notices that his toes are slightly swollen, reddened, and warm to the touch. What does the nurse suspect? a. Acute gout b. Osteoporosis c. Ankylosing spondylitis d. Degenerative joint disease

✅ANS: A Clinical findings for acute gout consist of redness, swelling, heat, and extreme pain like a continuous throbbing. Gout is a metabolic disorder of disturbed purine metabolism, associated with elevated serum uric acid. Osteoporosis is a decrease in skeletal bone mass leading to low bone mineral density and impaired bone density which increases the risk for fractures. It occurs primarily in postmenopausal white women. Ankylosing spondylitis is chronic inflamed vertebrae and is characterized by inflammatory back pain that is dull and deep in lower back or buttocks. Degenerative joint disease (osteoarthritis) is a localized, progressive disorder involving deterioration of articular cartilages and subchondral bone remodeling, synovial inflammation, and formation of new bone at joint surfaces. Asymmetric joint involvement commonly affects hands, knees, hips, and lumbar and cervical segments of the spine. This patient's symptoms are consistent with acute gout. DIF: Cognitive Level: Analyzing (Analysis) MSC: Client Needs: Physiological Integrity: Physiological Adaptation Chapter 23: Musculoskeletal System Jarvis: Physical Examination and Health Assessment, 8th Edition

A client takes celecoxib (Celebrex) for chronic osteoarthritis in multiple joints. After a knee replacement, the health care provider has prescribed morphine sulfate for postoperative pain relief. The client also requests the celecoxib in addition to the morphine. What action by the nurse is best? a. Consult with the health care provider about administering both drugs to the client. b. Inform the client that the celecoxib will be started when he or she goes home. c. Teach the client that, since morphine is stronger, celecoxib is not needed. d. Tell the client he or she should not take both drugs at the same time.

✅ANS: A Despite getting an opioid analgesic for postoperative pain, the nurse should be aware that the client may be on other medications for arthritis in other joints. The nonsteroidal anti-inflammatory drug celecoxib will also help with the postoperative pain. The nurse should consult the provider about continuing the celecoxib while the client is in the hospital. The other responses are not warranted, as the client should be restarted on this medication postoperatively. DIF: Applying/Application REF: 307 KEY: Postoperative nursing| nonsteroidal anti-inflammatory drugs (NSAIDs)| musculoskeletal disorders MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies Chapter 18: Care of Patients with Arthritis and Other Connective Tissue Diseases

2. A patient tells the nurse that she is having a hard time bringing her hand to her mouth when she eats or tries to brush her teeth. The nurse knows that for her to move her hand to her mouth, she must perform which movement? a. Flexion b. Abduction c. Adduction d. Extension

✅ANS: A Flexion, or bending a limb at a joint, is required to move the hand to the mouth. Extension is straightening a limb at a joint. Moving a limb toward the midline of the body is called adduction; abduction is moving a limb away from the midline of the body Chapter 23: Musculoskeletal System Jarvis: Physical Examination and Health Assessment, 8th Edition

The nurse on the postoperative inpatient unit assesses a client after a total hip replacement. The clients surgical leg is visibly shorter than the other one and the client reports extreme pain. While a co-worker calls the surgeon, what action by the nurse is best? a. Assess neurovascular status in both legs. b. Elevate the affected leg and apply ice. c. Prepare to administer pain medication. d. Try to place the affected leg in abduction.

✅ANS: A This client has manifestations of hip dislocation, a critical complication of this surgery. Hip dislocation can cause neurovascular compromise. The nurse should assess neurovascular status, comparing both legs. The nurse should not try to move the extremity to elevate or abduct it. Pain medication may be administered if possible, but first the nurse should thoroughly assess the client. DIF: Applying/Application REF: 311 KEY: Nursing assessment| joint replacement| musculoskeletal system MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

What action by the perioperative nursing staff is most important to prevent surgical wound infection in a client having a total joint replacement? a. Administer preoperative antibiotic as ordered. b. Assess the clients white blood cell count. c. Instruct the client to shower the night before. d. Monitor the clients temperature postoperatively.

✅ANS: A To prevent surgical wound infection, antibiotics are given preoperatively within an hour of surgery. Simply taking a shower will not help prevent infection unless the client is told to use special antimicrobial soap. The other options are processes to monitor for infection, not prevent it. DIF: Applying/Application REF: 310 KEY: Joint replacement| Surgical Care Improvement Project (SCIP)| wound infection| antibiotics MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

A client has rheumatoid arthritis (RA) and the visiting nurse is conducting a home assessment. What options can the nurse suggest for the client to maintain independence in activities of daily living (ADLs)? (Select all that apply.) a. Grab bars to reach high items b. Long-handled bath scrub brush c. Soft rocker-recliner chair d. Toothbrush with built-up handle e. Wheelchair cushion for comfort

✅ANS: A, B, D Test Bank - Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care 9e 136 Grab bars, long-handled bath brushes, and toothbrushes with built-up handles all provide modifications for daily activities, making it easier for the client with RA to complete ADLs independently. The rocker-recliner and wheelchair cushion are comfort measures but do not help increase independence. DIF: Applying/Application REF: 325 KEY: Rheumatoid arthritis| autoimmune disorders| activities of daily living| musculoskeletal system| functional ability MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort Chapter 18: Care of Patients with Arthritis and Other Connective Tissue Diseases

A patient is being assessed for range-of-joint movement. The nurse asks him to move his arm in toward the center of his body. What is this movement called? a. Flexion b. Abduction c. Adduction d. Extension

✅ANS: C Moving a limb toward the midline of the body is called adduction; moving a limb away from the midline of the body is called abduction. Flexion is bending a limb at a joint; and extension is straightening a limb at a joint Chapter 23: Musculoskeletal System Jarvis: Physical Examination and Health Assessment, 8th Edition

10. A home health care nurse is visiting a client discharged home after a hip replacement. The client is still on partial weight bearing and using a walker. What safety precautions can the nurse recommend to the client? (Select all that apply.) a. Buy and install an elevated toilet seat. b. Install grab bars in the shower and by the toilet. c. Step into the bathtub with the affected leg first. d. Remove all throw rugs throughout the house. e. Use a shower chair while taking a shower.

✅ANS: A, B, D, E Buying and installing an elevated toilet seat, installing grab bars, removing throw rugs, and using a shower chair will all promote safety for this client. The client is still on partial weight bearing, so he or she cannot step into the bathtub leading with the operative side. Stepping into a bathtub may also require the client to bend the hip more than the allowed 90 degrees. DIF: Applying/Application REF: 315 KEY: Joint replacement| osteoarthritis| home safety| assistive devices MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

A nurse is teaching a female client with rheumatoid arthritis (RA) about taking methotrexate (MTX) (Rheumatrex) for disease control. What information does the nurse include? (Select all that apply.) a. Avoid acetaminophen in over-the-counter medications. b. It may take several weeks to become effective on pain. c. Pregnancy and breast-feeding are not affected by MTX. d. Stay away from large crowds and people who are ill. e. You may find that folic acid, a B vitamin, reduces side effects.

✅ANS: A, B, D, E MTX is a disease-modifying antirheumatic drug and is used as a first-line drug for RA. MTX can cause liver toxicity, so the client should be advised to avoid medications that contain acetaminophen. It may take 4 to 6 weeks for effectiveness. MTX can cause immunosuppression, so avoiding sick people and crowds is important. Folic acid helps reduce side effects for some people. Pregnancy and breast-feeding are contraindicated while on this drug. DIF: Applying/Application REF: 322 KEY: Rheumatoid arthritis| autoimmune disease| patient education| disease-modifying antirheumatic drugs (DMARDs)| acetaminophen MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies Chapter 18: Care of Patients with Arthritis and Other Connective Tissue Diseases

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

✅ANS: 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 should ask about its use. The other questions all have an element of nontherapeutic communication in them. Compliant is a word associated with negative images, and the client may deny being noncompliant. Asking how much exercise the client really gets is accusatory. Asking if the client takes his or her medications right? is patronizing. DIF: Applying/Application REF: 309 KEY: Osteoarthritis| nursing assessment| supplements MSC: Integrated Process: Nursing Process: Assessment Chapter 18: Care of Patients with Arthritis and Other Connective Tissue Diseases

An 80-year-old woman is visiting the clinic for a checkup. She states, "I can't walk as much as I used to." What should the nurse have the patient do to observe for motor dysfunction in her hip? a. Internally rotate her hip while she is sitting. b. Abduct her hip while she is lying on her back. c. Adduct her hip while she is lying on her back. d. Externally rotate her hip while she is standing.

✅ANS: B Limited abduction of the hip while supine is the most common motion dysfunction found in hip disease. The other options are not correct. DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Health Promotion and Maintenance

During an interview the patient states, "I can feel this bump on the top of both of my shoulders—it doesn't hurt but I am curious about what it might be." What should the nurse tell this patient? a. "That is the subacromial bursa." b. "That is the acromion process." c. "That is the glenohumeral joint." d. "That is the greater tubercle of the humerus."

✅ANS: B The bump of the scapula's acromion process is felt at the very top of the shoulder. The other options are not correct. DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Health Promotion and Maintenance Chapter 23: Musculoskeletal System Jarvis: Physical Examination and Health Assessment, 8th Edition

A nurse works with several clients who have gout. Which types of gout and their drug treatments are correctly matched? (Select all that apply.) a. Allopurinol (Zyloprim) Acute gout b. Colchicine (Colcrys) Acute gout c. Febuxostat (Uloric) Chronic gout d. Indomethacin (Indocin) Acute gout e. Probenecid (Benemid) Chronic gout

✅ANS: B, C, D, E Acute gout can be treated with colchicine and indomethacin. Chronic gout can be treated with febuxostat and probenecid. Allopurinol is used for chronic gout. DIF: Remembering/Knowledge REF: 334 KEY: Gout| pain| pharmacologic pain management MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies Chapter 18: Care of Patients with Arthritis and Other Connective Tissue Diseases

1. The nurse is assessing the joints of a woman who has stated, "I have a long family history of arthritis, and my joints hurt." The nurse suspects that she has osteoarthritis. Which of these are symptoms of osteoarthritis? (Select all that apply.) a. Symmetric joint involvement b. Asymmetric joint involvement c. Pain with motion of affected joints d. Affected joints may have heat, redness, and swelling e. Affected joints are swollen with hard, bony protuberances

✅ANS: B,C,E In osteoarthritis, asymmetric joint involvement commonly affects hands, knees, hips, and lumbar and cervical segments of the spine. Affected joints have stiffness, swelling with hard bony protuberances, pain with motion, and limitation of motion. The other options reflect the signs of rheumatoid arthritis. DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Physiological Integrity: Physiological Adaptation Chapter 23: Musculoskeletal System Jarvis: Physical Examination and Health Assessment, 8th Edition

2.Which serum laboratory finding is of concern for the nurse and should be reported to the primary health care provider? A. Calcium = 9 mg/dL (2.10 mmol/L) B. Phosphorus = 4.5 mg/dL (1.45 mmol/L) C. Lactate dehydrogenase = 150 units/L (150 IU/L) D. Alkaline phosphatase = 210 units/L (210 IU/L)

✅Answer: D Rationale: The laboratory values for the Choices A, B, and C are all within normal limits. However, the normal value of alkaline phosphatase is 30-120 units/L (40-160 IU/L) and the value is much higher than the normal range value. Chapter 44 - Assessment of the Musculoskeletal System iggy

28. The nurse suspects that a patient has carpal tunnel syndrome and wants to perform the Phalen test. What instructions should the nurse give the patient to perform this test? a. Dorsiflex the foot. b. Plantarflex the foot. c. Hold both hands back to back while flexing the wrists 90 degrees for 60 seconds. d. Hyperextend the wrists with the palmar surface of both hands touching, and wait for 60 seconds.

✅ANS: C For the Phalen test, the nurse should ask the person to hold both hands back to back while flexing the wrists 90 degrees. Acute flexion of the wrist for 60 seconds produces no symptoms in the normal hand. The Phalen test reproduces numbness and burning in a person with carpal tunnel syndrome. The other actions are not correct when testing for carpal tunnel syndrome. DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Health Promotion and Maintenance Chapter 23: Musculoskeletal System Jarvis: Physical Examination and Health Assessment, 8th Edition

A teenage girl has arrived reporting pain in her left wrist. She was playing basketball when she fell and landed on her left hand. The nurse examines her hand. Which finding would lead the nurse to expect a fracture? a. Dull ache b. Deep pain in her wrist c. Sharp pain that increases with movement d. Dull throbbing pain that increases with rest

✅ANS: C A fracture causes sharp pain that increases with movement. The other types of pain do not occur with a fracture. DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Physiological Integrity: Physiological Adaptation

The nurse is providing patient education for a man who has been diagnosed with a rotator cuff injury. When explaining the structures involved in his injury, what should the nurse include? a. Nucleus pulposus b. Medial epicondyle c. Glenohumeral joint d. Articular processes

✅ANS: C A rotator cuff injury involves the glenohumeral joint, which is enclosed by a group of four powerful muscles and tendons that support and stabilize it. The other options are not in or near the rotator cuff or shoulder. The nucleus pulposus is located in the center of each intervertebral disk. The articular processes are projections in each vertebral disk that lock onto the next vertebra, thereby stabilizing the spinal column. The medial epicondyle is located at the elbow. DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Physiological Integrity: Physiological Adaptation Chapter 23: Musculoskeletal System Jarvis: Physical Examination and Health Assessment, 8th Edition

A client has a continuous passive motion (CPM) device after a total knee replacement. What action does the nurse delegate to the unlicensed assistive personnel (UAP) after the affected leg is placed in the machine while the client is in bed? a. Assess the distal circulation in 30 minutes. b. Change the settings based on range of motion. c. Raise the lower siderail on the affected side. d. Remind the client to do quad-setting exercises.

✅ANS: C Because the clients leg is strapped into the CPM, if it falls off the bed due to movement, the clients leg (and new joint) can be injured. The nurse should instruct the UAP to raise the siderail to prevent this from occurring. Assessment is a nursing responsibility. Only the surgeon, physical therapist, or specially trained technician adjusts the CPM settings. Quad-setting exercises are not related to the CPM machine. DIF: Applying/Application REF: 315 KEY: Joint replacement| delegation| continuous passive motion machine| unlicensed assistive personnel (UAP) MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care Chapter 18: Care of Patients with Arthritis and Other Connective Tissue Diseases

9. A patient who has had rheumatoid arthritis for years comes to the clinic to ask about changes in her fingers. The nurse will assess for signs of what problems? a. Heberden nodes b. Bouchard nodules c. Swan-neck deformities d. Dupuytren contractures

✅ANS: C Changes in the fingers caused by chronic rheumatoid arthritis include swan-neck and boutonniere deformities. Heberden nodes and Bouchard nodules are associated with osteoarthritis. Dupuytren contractures of the digits occur because of chronic hyperplasia of the palmar fascia. DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Physiological Integrity: Physiological Adaptation Chapter 23: Musculoskeletal System Jarvis: Physical Examination and Health Assessment, 8th Edition

A patient states, "I can hear a crunching or grating sound when I kneel." She also states that "it is very difficult to get out of bed in the morning because of stiffness and pain in my joints." The nurse should assess for signs of what problem? a. Bone spur b. Tendonitis c. Crepitation d. Fluid in the knee joint

✅ANS: C Crepitation is an audible and palpable crunching or grating that accompanies movement and occurs when articular surfaces in the joints are roughened, as with rheumatoid arthritis. A bone spur is a bony projection (osteophyte) that develops along a bone edge, usually where bones meet at a joint. They often do not cause pain, but when they do, it is usually pain with movement in the specific joint with the bone spur. Tendonitis is an inflammation of a tendon and produces a swelling and tenderness to that one spot in the joint and affects only certain planes of ROM, especially during active ROM. Excess fluid in the knee can cause swelling and difficulty moving the knee, but usually does not cause pain, although the disease process causing the fluid (e.g. rheumatoid arthritis, osteoarthritis) may cause pain. The symptoms this patient is experiencing (audible and palpable crunching when kneeling indicates crepitation. Crepitation is an audible and palpable crunching or grating that accompanies movement and occurs when articular surfaces in the joints are roughened, as with rheumatoid arthritis. DIF: Cognitive Level: Analyzing (Analysis) MSC: Client Needs: Physiological Integrity: Physiological Adaptation

A patient's annual physical examination reveals a lateral curvature of the thoracic and lumbar segments of his spine; however, this curvature disappears with forward bending. What is this abnormality called? a. Dislocated hip b. Structural scoliosis c. Functional scoliosis d. Herniated nucleus pulposus

✅ANS: C Functional scoliosis is flexible and apparent with standing but disappears with forward bending. Structural scoliosis is fixed; the curvature shows both when standing and when bending forward. These findings are not indicative of a herniated nucleus pulposus or dislocated hip. DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Safe and Effective Care Environment: Management of Care Chapter 23: Musculoskeletal System Jarvis: Physical Examination and Health Assessment, 8th Edition

A 14-year-old boy who has been diagnosed with Osgood-Schlatter disease reports painful swelling just below the knee for the past 5 months. Which response by the nurse is appropriate? a. "If these symptoms persist, you may need arthroscopic surgery." b. "You are experiencing degeneration of your knee, which may not resolve." c. "Your disease is due to repeated stress on the patellar tendon. It is usually self-limited, and your symptoms should resolve with rest." d. "Increasing your activity and performing knee-strengthening exercises will help decrease the inflammation and maintain mobility in the knee."

✅ANS: C Osgood-Schlatter disease is a painful swelling of the tibial tubercle just below the knee and most likely due to repeated stress on the patellar tendon. It is usually self-limited, occurring during rapid growth and most often in boys. The symptoms resolve with rest. The other responses are not appropriate. DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Physiological Integrity: Physiological Adaptation Chapter 23: Musculoskeletal System Jarvis: Physical Examination and Health Assessment, 8th Edition

Top contraindication to joint replacement a. Age b. Body weight c. Severe osteoporosis d. Urinary tract infection

✅ANS: C Osteoporosis is a contraindication to joint replacement because the bones have a high risk of shattering as the new prosthesis is implanted. The client who needs fillings should have them done prior to the surgery. Age greater than 85 is not an absolute contraindication. A urinary tract infection can be treated prior to surgery. DIF: Remembering/Knowledge REF: 309 KEY: Osteoarthritis| osteoporosis| joint replacement| surgical procedures MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential Chapter 18: Care of Patients with Arthritis and Other Connective Tissue Diseases

A patient is reporting pain in his joints that is worse in the morning, better after he moves around for a while, and then gets worse again if he sits for long periods. The nurse should assess for other signs of what problem? a. Tendinitis b. Osteoarthritis c. Rheumatoid arthritis d. Intermittent claudication

✅ANS: C Rheumatoid arthritis pain is worse in the morning when a person arises and then improves with movement. Movement increases most other types of joint pain. DIF: Cognitive Level: Analyzing (Analysis) MSC: Client Needs: Physiological Integrity: Physiological Adaptation Chapter 23: Musculoskeletal System Jarvis: Physical Examination and Health Assessment, 8th Edition

. A patient is able to flex his right arm forward without difficulty or pain but is unable to abduct his arm because of pain and muscle spasms. What does the nurse suspect? a. Crepitation b. Rheumatoid arthritis c. Rotator cuff lesions d. A dislocated shoulder

✅ANS: C Rotator cuff lesions may limit range of motion and cause pain and muscle spasms during abduction, whereas forward flexion remains fairly normal. Crepitation is an audible and palpable crunching or grating that accompanies movement and occurs when articular surfaces in the joints are roughened, as with rheumatoid arthritis. Rheumatoid arthritis is a chronic inflammatory pain condition in the joints. Joint involvement is symmetric and bilateral, with heat, redness, swelling, and painful motion of affected joints. A dislocated shoulder shows an obvious deformity and severe pain with movement.

The nurse is caring for a client with systemic sclerosis (SSc). What comfort measures can the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) a. Collaborate with a registered dietitian for appropriate foods. b. Inspect the skin and note any areas of ulceration. c. Keep the room at a comfortably warm temperature. d. Place a foot cradle at the end of the bed to lift sheets. e. Remind the client to elevate the head of the bed after eating.

✅ANS: C, D, E The client with SSc should avoid cold temperatures, which may lead to vasospasms and Raynauds phenomenon. The UAP can adjust the room temperature for the clients comfort. Keeping the sheets off the feet will help prevent injury; the UAP can apply a foot cradle to the bed to hold the sheets up. Because of esophageal problems, the client should remain in an upright position for 1 to 2 hours after meals. The UAP can remind the client of this once he or she has been taught. The other actions are performed by the registered nurse. DIF: Applying/Application REF: 329 KEY: Systemic scleroderma| autoimmune disorders| delegation| nonpharmacologic pain management MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

The nurse has completed the musculoskeletal examination of a patient's knee and has found a positive bulge sign. How does the nurse interpret this finding? a. Irregular bony margins b. Soft-tissue swelling in the joint c. Swelling from fluid in the epicondyle d. Swelling from fluid in the suprapatellar pouch

✅ANS: D A positive bulge sign confirms the presence of swelling caused by fluid in the suprapatellar pouch. The other options are not correct. DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Physiological Integrity: Physiological Adaptation

2. When assessing muscle strength, the nurse observes that a patient has complete range of motion against gravity with full resistance. What grade of muscle strength should the nurse record using a 0- to 5-point scale? a. 2 b. 3 c. 4 d. 5

✅ANS: D Complete range of motion against gravity is normal muscle strength and is recorded as grade 5 muscle strength. The other options are not correct. DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Physiological Integrity: Physiological Adaptation

An older client has returned to the surgical unit after a total hip replacement. The client is confused and restless. What intervention by the nurse is most important to prevent injury? a. Administer mild sedation. b. Keep all four siderails up. c. Restrain the clients hands. d. Use an abduction pillow.

✅ANS: D Older clients often have trouble metabolizing anesthetics and pain medication, leading to confusion or restlessness postoperatively. To prevent the hip from dislocating, the nurse should use an abduction pillow since the client cannot follow directions at this time. Sedation may worsen the clients mental status and should be avoided. Using all four siderails may be considered a restraint. Hand restraints are not necessary in this situation. DIF: Applying/Application REF: 311 KEY: Joint replacement| abduction pillow| musculoskeletal system| older adult MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential Chapter 18: Care of Patients with Arthritis and Other Connective Tissue Diseases

A 68-year-old woman has come in for an assessment of her rheumatoid arthritis, and the nurse notices raised, firm, nontender nodules at the olecranon bursa and along the ulna. What is the appropriate term for these nodules? a. Epicondylitis b. Gouty arthritis c. Olecranon bursitis d. Subcutaneous nodules.

✅ANS: D Subcutaneous nodules are raised, firm, and nontender and occur with rheumatoid arthritis in the olecranon bursa and along the extensor surface of the ulna. Epicondylitis (Tennis elbow) is pain at the lateral epicondyle of the humerus. Gout is a painful inflammatory arthritis characterized by excess uric acid in the blood and deposits of urate crystals in the joint space. Symptoms include redness, swelling, heat and extreme pain. Olecranon bursitis is a large, soft knob or "goose egg" and redness from swelling and inflammation of olecranon bursa. DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Safe and Effective Care Environment: Management of Care Chapter 23: Musculoskeletal System Jarvis: Physical Examination and Health Assessment, 8th Edition

. A professional tennis player comes into the clinic complaining of a sore elbow. Where should the nurse assess for tenderness? a. Olecranon bursa b. Annular ligament c. Base of the radius d. Medial and lateral epicondyle

✅ANS: D The epicondyles, the head of the radius, and the tendons are common sites of inflammation and local tenderness, commonly referred to as tennis elbow. The other locations are not affected. DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Physiological Integrity: Physiological Adaptation

5 of 16 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 Tramadol Gabapentin

✅Acetaminophen Several major medical organizations, including the American Pain Society and OARSI committee recommend acetaminophen as the primary drug of choice. Chapter 46 - Concepts of Care for Patients With Arthritis and Total Joint Arthroplasty

11 of 11 The nurse is reviewing the laboratory test results for a client who was diagnosed with muscular dystrophy (MD) as a child. Which lab results will the nurse expect to be elevated? (Select all that apply.) Select all that apply. Alkaline phosphatase Aldolase Calcium Lactic dehydrogenase (LDH) Creatine kinase (CK-MM)

✅Alkaline phosphatase ✅Aldolase ✅Lactic dehydrogenase (LDH) ✅Creatine kinase (CK-MM) Muscular dystrophy is a group of genetically linked diseases that cause chronic skeletal muscle weakness and organ dysfunction due to smooth muscle involvement. Therefore, this disease affects muscles which cause elevations of muscle enzymes. Chapter 44 - Assessment of the Musculoskeletal System iggy

1. The nurse is caring for a client with severe osteoarthritis. What will the nurse anticipate as the client's priority problem? A. Joint pain B. ADL dependence C. Risk for falls D. Muscle stiffness

✅Answer: A Rationales: Osteoarthritis indicates a joint disease in which bone cartilage degenerates causing joint pain and secondary inflammation (Choice A). The client often experiences muscle stiffness which is not as uncomfortable as joint pain (Choice D). Clients who have severe osteoarthritis are not necessarily dependent in ADLs or at risk for falling (Choice B and C). Chapter 46 - Concepts of Care for Patients With Arthritis and Total Joint Arthroplasty

A client had a left noncemented posterolateral total hip arthroplasty 2 days ago. Which statements will the nurse include in health teaching for the client? Select all that apply. A.​ "Practice leg exercises each day as instructed." B.​ "Take deep breaths and use incentive spirometry every 2 hours." C.​ "Be sure to cross your legs to be more comfortable in a chair." D.​ "Report sudden increased hip pain or rotation immediately to the nurse." E.​ "Stand on your right leg and pivot into the chair when getting out of bed."

✅Answer: A, B, D, E Rationales: The client who had a posterolateral surgical approach is at risk for hip dislocation and should be taught NOT cross his or her legs which cause adduction. Therefore, Choice C is an incorrect response. All clients having a total hip arthroplasty are at risk for clotting and leg exercises can help reduce that risk (Choice A). Taking deep breaths and using incentive spirometry are important for all surgical clients to prevent pneumonia or ateletasis (Choice B). Choice D is important for client teaching because these signs and symptoms may indicate hip dislocation. Clients with noncemented implants should not initially bear weight on the affected leg (Choice E). Chapter 46 - Concepts of Care for Patients With Arthritis and Total Joint Arthroplasty

Which assessment findings will the nurse expect for the client with early-stage rheumatoid arthritis? Select all that apply. A.​ Joint inflammation B.​ Subcutaneous nodules C.​ Severe weight loss D.​ Fatigue E.​ Thrombocytosis F.​ Anorexia

✅Answer: A, D, F Rationales: Subcutaneous nodules (Choice B), severe weight loss (Choice C) and thrombocytosis (Choice E) are all commonly seen in clients with late-stage, advanced RA. Joint inflammation (Choice A) is common in early disease and often occurs with client reports of fatigue and anorexia (Choices D and F). Chapter 46 - Concepts of Care for Patients With Arthritis and Total Joint Arthroplasty

​Which specific information will the nurse teach to the client with systemic lupus erythematosus newly prescribed belimumab therapy? A. Avoid injecting it in a site near a cutaneous lesion. B. The drug can only be given by a health care professional. C. Do not chew, crush, or split the tablet containing this drug. D. The drug must be taken at bedtime because it causes extreme drowsiness.

✅Answer: B Rationale: The drug is a monoclonal antibody given parenterally. It is composed of some foreign proteins and has been known to cause anaphylaxis even 2 hours after administration. Thus, it must be given by a health care professional in a setting capable of handling an anaphylactic emergency. It must not be self-administered. The drug is not available in tablet form. Belimumab does not induce drowsiness and can be administered at any time of day. Cognitive Level: Applying or higher Client Needs Category: Health Promotion and Maintenance Nursing Process Step: Implementation Chapter 18: Care of Patients with Arthritis and Other Connective Tissue Diseases

2. The nurse is caring for a client who had a posterolateral total his arthroplasty yesterday. For which commonly occurring postoperative complication will the nurse monitor for this client? A. Pneumonia B. Paralytic ileus C. Wound dehiscence D. Surgical hip dislocation

✅Answer: D Rationales: Even with aggressive preventive interventions, the client who has a total hip arthroplasty (THA) is at most risk for the common complication of venous thromboembolism. The other choices are much less common for clients having a THA, and would be seen in clients having other types of surgery. Chapter 46 - Concepts of Care for Patients With Arthritis and Total Joint Arthroplasty

The primary health care provider prescribes daily celecoxib for a client experiencing persistent joint pain in both knees. Which health teaching will the nurse provide for the client regarding this drug for long term pain control? Select all that apply. A.​"Take the prescribed drug before breakfast each day." B.​"Report any sign of bleeding, including bloody or dark, tarry stool." C.​"Do not take other NSAIDs while on celecoxib." D.​"Report any major changes in the amount of urine you excrete each day." E.​"Follow up with lab tests to assess liver function."

✅Answer: B, C, D Rationales: Celecoxib is a COX-2 inhibiting NSAID and therefore can cause many adverse effects including GI symptoms, such as bleeding (Choice B), and acute kidney injury which is manifested by decreased urinary output (Choice D). Other NSAIDs should be avoided to reduce potential adverse effects (Choice C). All NSAIDs should be taken with meals or food to decrease GI effects, making Choice A the wrong response. Lab tests to measure liver function are more likely requested for patients taking acetaminophen, so Choice E is not appropriate for celecoxib therapy. Chapter 46 - Concepts of Care for Patients With Arthritis and Total Joint Arthroplasty

3. The nurse is assessing a client who has late-stage rheumatoid arthritis. Which assessment findings would the nurse expect for this client? Select all that apply. A. Joint inflammation B. Severe weight loss C. Bony nodules D. Joint deformities E. Sjogren's syndrome

✅Answer: B, D, E Rationales: Although rheumatoid arthritis (RA) is an inflammatory disease, clients with late-stage disease have joint deformity rather than inflammation (Choice A and D). Bony nodules occur in clients who have osteoarthritis; subcutaneous nodules are more common in clients with RA (Choice C). Severe weight loss and possibly Sjogren's syndrome are common in clients with late-stage RA (Choice B and E). Chapter 46 - Concepts of Care for Patients With Arthritis and Total Joint Arthroplasty

​Which action will the nurse perform first for a client in anaphylaxis to prevent harm? A. Applying oxygen by nonrebreather mask B. Administering IV diphenhydramine C. Injecting epinephrine D. Initiating IV access

✅Answer: C Rationale: All actions are appropriate interventions for the client having an anaphylactic reaction. The first and most important action is to inject the epinephrine to stop the attack. Administering oxygen is helpful in supporting the client but will not stop this extremely rapid response and will take time away from administering the epinephrine. Giving diphenhydramine is a second line therapy for anaphylaxis. Initiating IV access is important but may not even be possible if the blood pressure is too low during anaphylaxis. Time should not be wasted on this action. Cognitive Level: Applying or Higher Client Needs Category: Safe and Effective Care Environment Nursing Process Step: Implementation Chapter 18: Care of Patients with Arthritis and Other Connective Tissue Diseases

​Which new onset condition or symptom in a client who has systemic lupus erythematosus (SLE) now taking hydroxychloroquine does the nurse deem to have the highest priority for immediate reporting to prevent harm? A. Increased bruising B. Increased daily output of slightly foamy urine C. Failure to see letters in the middle of a word D. Sensation of nausea within an hour of taking the drug

✅Answer: C Rationale: Hydoxychloroquine can be toxic to retinal cells, especially near the macula. This would result in decreased or lost central vision such as would be seen as "missing" letters in the center of a word being read. Bruising is an expected side effect of the drug because is decreases clotting. Although foamy urine is an early indicator of protein in the urine and would need to be addressed, it is not as pressing a problem as the decreased central vision, which is irreversible and an indication that the drug must be stopped immediately. Nausea, although unpleasant, does not have a high risk for causing harm. Cognitive Level: Applying or Higher Client Needs Category: Physiological Integrity Nursing Process Step: Evaluation Chapter 18: Care of Patients with Arthritis and Other Connective Tissue Diseases

A client returns to the post-anesthesia care unit (PACU) after an arthroscopy to repair a shoulder injury. What is the nurse's priority when caring for this client? A.​ Keep the affected arm elevated and immobilized. B.​ Ensure that the patient uses the patient-controlled analgesia (PCA) pump. C.​ Check the neurovascular status of the affected arm. D.​ Instruct the client to stay in bed for 24 hours.

✅Answer: C Rationale: Choice C is the best answer because postoperative swelling or bleeding can compress arterial and nerve supply to the entire arm. Therefore, performing a neurovascular assessment on the affected arm can detect any vascular or nerve changes that may need medical treatment. Choice A is also important to prevent increased swelling, but is not as important of a concern for the nurse. The client may or may not have a PCA pump (choice B) and would not need to stay in bed for 24 hours (choice D). Chapter 44 - Assessment of the Musculoskeletal System iggy

An unlicensed assistive personnel (UAP) is assigned to care for a client who had a cemented total knee arthroplasty yesterday. Which observation by the UAP indicates a need for follow-up by the nurse? A.​ "The client's surgical knee is very swollen and discolored." B.​ "The client states that the surgical knee is very painful when moving it." C.​ "The client's lower leg on the surgical side is painful and red." D.​ "The client needs assistance with walking to the bathroom.

✅Answer: C Rationales: A client who had a TKA one-day ago is expected to have a swollen and discolored surgical knee that is very painful when moving. The client is also expected to need assistance with a walker and possibly a staff member when ambulating. Therefore, Choices A, B, and D do not require follow-up by the nurse. However, redness, pain, and possibly swelling of the lower leg may indicate deep vein thrombosis which requires follow-up and assessment by the nurse (Choice C). Chapter 46 - Concepts of Care for Patients With Arthritis and Total Joint Arthroplasty

​A client who is six feet two inches tall and weighs 205 lb is having an anaphylactic reaction. Which dose of epinephrine will the nurse prepare for this client? A. 0.3 mL of a 1:10,000 solution B. 0.5 mL of a 1:10,000 solution C. 0.3 mL of a 1:1000 solution D. 0.5 mL of a 1:1000 solution

✅Answer: D Rationale: The dosage of epinephrine needed to be of benefit during an anaphylactic reaction is based on size. Adults are prescribed doses ranging from 0.3 mL to 0.5 mL of a 1:1000 solution. A solution of 1:10,000 will be ineffective unless the dose is massive. This client is larger than average and needs a larger dose of the solution. Cognitive Level: Applying or higher Client Needs Category: Safe and Effective Care Environment Nursing Process Step: Implementation Chapter 18: Care of Patients with Arthritis and Other Connective Tissue Diseases

.​Which statement(s) regarding type III hypersensitivity reactions is/are true? Select all that apply. A. Type III responses are usually directed against self cells and tissues. B. Susceptibility for developing a type III hypersensitivity response follows an autosomal dominant pattern of inheritance. C. The hypersensitivity starts as a type II reaction that progresses to a type III reaction. D. The major mechanism of the reaction is the release of mediators from sensitized T-cells that trigger antigen destruction by macrophages. E. Rheumatoid arthritis is an example of a health problem caused by this type of hypersensitivity. F. The second phase of the reaction with accumulation of excess bradykinin is responsible for development of angioedema.

✅Answers: A, E Rationale: Type III reactions are responsible for the generation of autoantibodies that attack self cells and tissues as part of autoimmune disorders. Rheumatoid arthritis is a classic example of a type III response generating autoimmunity. Although this type of reaction results from a genetic susceptibility combined with a triggering event, the pattern of inheritance is not discernable and most likely represents a polygenic effect. A type II response is generated by a foreign cell or protein that attaches to a normal body cell. When the antigen is attacked, the normal cell attached to it also is attacked. It does not progress to a type III autoimmune response. Although macrophages may be involved in some aspect of tissue injury with autoimmune disorders, the main mechanism is the development of autoantibodies from B-cells. Bradykinin and angioedema are features of a type I hypersensitivity and are not associated with type III responses. Cognitive Level: Understanding Client Needs Category: Physiological Integrity Nursing Process Step: N/A Chapter 18: Care of Patients with Arthritis and Other Connective Tissue Diseases

​Which statement(s) regarding type I hypersensitivity reactions is/are true? Select all that apply. A. Antihistamines are of minimal benefit because the reactions are mediated by IgE rather than histamine. B. The response is characterized by the five cardinal symptoms of inflammation. C. Type I responses are usually directed against nonself but the response is excessive. D. Susceptibility for developing a type I hypersensitivity response follows an X-linked recessive pattern of inheritance. E. This type of hypersensitivity reaction is most strongly associated with systemic lupus erythematosus. F. Responses always occur within minutes of exposure to the allergen. G. The second phase of the reaction with accumulation of excess bradykinin is responsible for development of angioedema.

✅Answers: B, C, G Rationale: Type I responses Type I reactions result from the increased production of the immunoglobulin E (IgE) antibody class that cause the release of mediators including histamine, bradykinin, leukotriene, and others that result in the five cardinal symptoms of inflammation (pain, swelling, warmth, redness, and loss of function). The reactions are directed against appropriate nonself targets rather than against self cells but the responses are excessive. The second phase of type I reactions are caused by accumulation of bradykinin deep within the skin tissue layers, which is the major mechanism of angioedema. Antihistamines are helpful with a type I hypersensitivity reaction because the major mediator is histamine. Although the susceptibility to type I reactions is genetic, no specific pattern of inheritance has been identified. Many type I reactions do occur rapidly after exposure to the allergen; however, angioedema is a pure type I reaction and may not occur until days, weeks, months, and even years after continual exposure to the allergen. Cognitive Level: Understanding Client Needs Category: Physiological Integrity Nursing Process Step: N/A Chapter 18: Care of Patients with Arthritis and Other Connective Tissue Diseases

14 of 16 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.) Select all that apply. Apply pneumatic or sequential compression devices. Administer anticoagulant therapy. Ambulate the client on the day of surgery. Elevate the client's legs. Keep the legs slightly abducted.

✅Apply pneumatic or sequential compression devices. ✅Administer anticoagulant therapy. ✅Ambulate the client on the day of surgery. Preventive postoperative actions that help prevent VTE include pharmacology (anticoagulants), ambulation, and compression. Chapter 46 - Concepts of Care for Patients With Arthritis and Total Joint Arthroplasty

4 of 18 Which action is the priority for the nurse to take to prevent harm for the alert 58-year-old client who is admitted to the emergency department with wheezing, dyspnea, angioedema, blood pressure of 70/52 mm Hg, and an irregular apical pulse of 122 beats/min? Asking about exposure to possible allergens Applying oxygen via a high-flow nonrebreather mask at 90% to 100% Reassuring the client that appropriate interventions are being instituted Starting an IV infusion of normal saline

✅Applying oxygen via a high-flow nonrebreather mask at 90% to 100% The immediate priority is to apply oxygen in order to provide adequate oxygenation for the client who is in respiratory distress. Raising the lower extremities, starting an IV infusion, and reassuring the client are not the first priority for a client in respiratory distress.

15 of 16 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.) Select all that apply. Establish trust and explain the postoperative pain management plan. Consult the pain management team if needed and available. Plan continuing pain management after discharge. Use multimodal and alternative pain management modalities. Identify at-risk clients preoperatively using a comprehensive assessment.

✅CORRECT Establish trust and explain the postoperative pain management plan. All of these interventions are needed to successfully manage pain for clients who have persistent (chronic) pain. CORRECT Consult the pain management team if needed and available. All of these interventions are needed to successfully manage pain for clients who have persistent (chronic) pain. CORRECT Plan continuing pain management after discharge. All of these interventions are needed to successfully manage pain for clients who have persistent (chronic) pain. CORRECT Use multimodal and alternative pain management modalities. All of these interventions are needed to successfully manage pain for clients who have persistent (chronic) pain. CORRECT Identify at-risk clients preoperatively using a comprehensive assessment. All of these interventions are needed to successfully manage pain for clients who have persistent (chronic) pain. Chapter 46 - Concepts of Care for Patients With Arthritis and Total Joint Arthroplasty

9 of 16 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? Penicillin Clindamycin Vancomycin Cefazolin

✅Cefazolin Cephalosporins are the drug class of choice for clients without allergies who are having a total joint arthroplasty. Chapter 46 - Concepts of Care for Patients With Arthritis and Total Joint Arthroplasty

11 of 16 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? Monitor vital signs frequently to detect early complications. 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.

✅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 Chapter 46 - Concepts of Care for Patients With Arthritis and Total Joint Arthroplasty

A mother brings her newborn baby boy in for a checkup; she tells the nurse that he does not seem to be moving his right arm as much as his left and that he seems to have pain when she lifts him up under the arms. The nurse suspects a fractured clavicle. What finding would support this suspicion? a. Negative Allis test b. Positive Ortolani sign c. Limited range of motion during Lasègue test d. Limited range of motion during the Moro reflex

✅D For a fractured clavicle, the nurse should observe for limited arm range of motion and unilateral response to the Moro reflex. The Allis test and Ortolani sign are performed to assess for hip dislocations, not fractured clavicle. The Lasègue test is performed to assess for sciatica or herniated nucleus pulposus. For a fractured clavicle, the nurse should observe for limited arm range of motion and unilateral response to the Moro reflex. The other tests are not appropriate for this type of fracture. DIF: Cognitive Level: Applying (Application) MSC: Client Needs: Health Promotion and Maintenance

9 of 18 What precaution is most important for the nurse to teach the client with systemic lupus erythematosus (SLE) prescribed to take 45 mg of a corticosteroid daily for 2 weeks to manage an SLE flare? Check all your stools for the presence of blood or a black, tarry appearance. Do not suddenly stop taking the drug when your flare is over. Be sure to take this drug with food. Take 30 mg in the morning and 15 mg at night.

✅Do not suddenly stop taking the drug when your flare is over. All of the precautions are correct and important. However, the most critical precaution is to not suddenly stop taking the drug, which could lead to acute adrenal insufficiency and even death. This dose of the drug (45 mg daily) would need to be tapered down over a period of weeks to prevent adrenal insufficiency.

8 of 16 The nurse assesses a client diagnosed with Sjögren syndrome. The nurse anticipates that the client will also have which symptom? Excessive production of saliva in the mouth Intermittent episodes of diarrhea Abdominal bloating after eating Dry eyes

✅Dry eyes Clients with Sjögren syndrome experience dry eyes (keratoconjunctivitis sicca), dry mouth, and if female, dry vagina. Chapter 46 - Concepts of Care for Patients With Arthritis and Total Joint Arthroplasty

6 of 16 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? Massage and hypnosis. Hot compresses or moist heating pad. Glucosamine and chondroitin combination. Ice packs used every 3 to 4 hours during the day.

✅Glucosamine and chondroitin combination. 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. Chapter 46 - Concepts of Care for Patients With Arthritis and Total Joint Arthroplasty

3 of 16 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 Chapter 46 - Concepts of Care for Patients With Arthritis and Total Joint Arthroplasty

17 of 18 After a client is hospitalized for an anaphylactic reaction to a bee sting, a nurse is teaching the client about the use of an epinephrine autoinjector. Which instruction/ instructions should be included in client education? (Select all that apply.) Select all that apply. Keep the device with you at all times. After administering the device, hospital monitoring is necessary. Use the device before calling 911. If the drug becomes discolored, order a replacement device. The device CANNOT be given through clothing. Inject the device into your arm or your leg.

✅Keep the device with you at all times. ✅After administering the device, hospital monitoring is necessary. ✅Use the device before calling 911. ✅If the drug becomes discolored, order a replacement device. Instruct the client to utilize the device at the first symptom of anaphylactic reaction before calling 911. Hospital monitoring is always necessary after utilizing epinephrine for anaphylaxis. The device should be available at all times, as allergens can be encountered in all life situations. For client safety if the drug becomes discolored, it needs to be replaced. The device CAN be given through a thin layer of clothing. The ideal injection site for an epinephrine automatic injector is in the upper thigh.

10 of 11 The nurse is performing a focused musculoskeletal assessment on an older female client. What assessment findings associated with aging would the nurse expect? (Select all that apply.) Select all that apply. Scoliosis Kyphosis Decreased range of motion Muscle atrophy Osteoarthritis Widened gait

✅Kyphosis ✅Decreased range of motion ✅Muscle atrophy ✅Osteoarthritis ✅Widened gait All of these assessment findings are associated with aging, especially in women, except for scoliosis. Scoliosis is a lateral curvature of the spine that is usually diagnosed in children and adolescents Chapter 44 - Assessment of the Musculoskeletal System iggy

4 of 11 When assessing a female client, the nurse learns that the client has several risk factors for osteoporosis. Which risk factor would be the priority for client teaching? Low calcium intake Postmenopausal status Positive family history Previous use of steroids

✅Low calcium intake The client's calcium and vitamin D intake is the priority risk factor that the client can change. The nurse will discuss the other risk factors as contributing to osteoporosis, but the teaching will focus on ways to increase calcium intake. Postmenopausal status, positive family history, and previous use of steroids are not risk factors that the client can change. These risk factors should be discussed but are not the priority for this client. Chapter 44 - Assessment of the Musculoskeletal System iggy

5 of 18 What is the most important action to prevent harm for the nurse to perform after a client's oral and facial swelling from an angiotensin-converting enzyme inhibitor (ACEI) have resolved? Teaching the client about symptoms to report immediately to the primary health care provider Instructing the client to discard the offending drug after being discharged Monitoring the client for return of symptoms for at least the next 2 to 4 hours Assessing the vein above the IV infusion site for a firm, cordlike texture

✅Monitoring the client for return of symptoms for at least the next 2 to 4 hours All actions are important, although phlebitis is not likely to occur from IV therapy for angioedema. The ACEI class of drugs have a longer half-life and remain in the body longer than does the corticosteroid infusion used to treat the angioedema. As a result, symptoms can recur after first resolving when corticosteroid therapy is stopped. The client remains at risk and must be monitored for at least 2 to 4 hours for return of angioedema

Which aspect of postoperative management will the nurse plan to discuss with a client about to undergo an arthroscopic repair of the knee? Pharmacy for client medications Physical therapy for exercises Social work for care coordination Registered dietitian for nutrition

✅Physical therapy for exercises The nurse and the physical therapist will discuss postoperative physical therapy with the client and will assess and collaborate on the postoperative exercises which will be necessary to establish ROM after the procedure. It is the nurse's responsibility to assess which medications the client is currently taking. Nutritional assessment is performed by the nurse, but this might also involve a dietitian if special needs exist. Unless there are postoperative complications or if the client has a variety of special needs, care coordination is not necessary. Chapter 44 - Assessment of the Musculoskeletal System iggy

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? Report of muscle spasms Inability to get dressed without assistance Report of feelings of anger Refusal to look at the affected limb

✅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. Inability to get dressed without assistance Clients who have an amputation are likely to need assistance with dressing and hygiene. Promoting the client's ability to perform self-care is important because it fosters client independence; however, there is a different finding that is the priority. Report of feelings of anger Clients who have an amputation might report feelings of anger while grieving the loss of a limb. Helping the client to express feelings is important to support the client through the grieving process; however, there is a different finding that is the priority. Refusal to look at the affected limb Clients who have an amputation might refuse to acknowledge the site of the lost limb. Encouraging the client to look at and care for the limb is important to help the client develop a positive body image; however, there is a different finding that is the priority.

11 of 18 Which precaution is a priority to prevent harm for the nurse to teach a client with systemic lupus erythematosus (SLE) who is newly prescribed to take hydroxychloroquine for disease management? See your ophthalmologist for visual field testing every 6 months. Report a reduction of joint swelling to your rheumatology health care provider immediately. Report a worsening of joint swelling to your rheumatology health care provider immediately. See your ophthalmologist for intraocular pressure measurement every 6 months.

✅See your ophthalmologist for visual field testing every 6 months. Hydroxychloroquine has both immunomodulating and anticlotting effects that can be beneficial to clients with SLE. A major complication of this drug is its toxicity to retinal cells causing retinitis that can lead to an irreversible loss of central vision. Clients prescribed hydroxychloroquine are instructed to have frequent eye examinations with visual field testing (before starting the drug and every 6 months thereafter). If retinal toxicity is suspected, the drug is discontinued to preserve the remaining vision.

10 of 16 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 does not need to have labs drawn for PT or INR. The client only needs to take the drug while in the hospital. The client is not at risk for bleeding or bruising. The client does not need to wear sequential compression devices.

✅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. Chapter 46 - Concepts of Care for Patients With Arthritis and Total Joint Arthroplasty

16 of 18 Which statement(s) regarding type IV hypersensitivity reactions is/are true? (Select all that apply.) Select all that apply. The major mechanism of the reaction is the release of mediators from sensitized T-cells that trigger antigen destruction by macrophages. Type IV responses are usually directed against non-self but the response is excessive. The second phase of the reaction with accumulation of excess bradykinin is responsible for development of angioedema. The secondary phase, when prolonged, is primarily responsible for autoimmune disorders. Rashes and blister formation from poison ivy exposure are a typical response for this type of hypersensitivity reaction. Antihistamines are of minimal benefit because the reactions are mediated by IgE rather than histamine.

✅The major mechanism of the reaction is the release of mediators from sensitized T-cells that trigger antigen destruction by macrophages ✅Type IV responses are usually directed against non-self but the response is excessive. ✅Rashes and blister formation from poison ivy exposure are a typical response for this type of hypersensitivity reaction. ✅Antihistamines are of minimal benefit because the reactions are mediated by IgE rather than histamine Type IV delayed hypersensitivity reactions have T-lymphocytes (T-cells) as the activated immune system component triggering the excessive responses. A classic example is allergy to poison ivy. Sensitized T-cells (from a previous exposure) respond to an antigen by releasing chemical mediators and triggering macrophages to destroy the antigen; however, histamine is not one of the mediators, making antihistamines of minimal benefit. A type IV response with edema, induration, ischemia, and tissue damage at the site of the exposure typically occurs hours to days after exposure. Angioedema is a type I response, not a type IV response.

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? Use a hair dryer on a cool setting to blow air into the cast. Ask the provider to bivalve the cast. Provide the client with a sterile cotton swab to rub the affected skin. Wrap the extremity with a dry heating pad.

✅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. Ask the provider to bivalve the cast. The nurse should recognize that cast bivalving is used relieve pressure when a cast becomes too tight on the affected extremity. Provide the client with a sterile cotton swab to rub the affected skin. The nurse should instruct the client not to place any foreign object under the cast to prevent injury to the skin. Wrap the extremity with a dry heating pad. The nurse should avoid using heat on a casted extremity because it can increase edema.

16 of 16 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.) Select all that apply. Using nasal mupirocin for at least a week before surgery Avoiding sleeping with pets in the client's bed Showering the night before and the morning of surgery with chlorhexidine Giving antibiotics before and after surgery for at least 3 days Sleeping on clean linen wearing clean nightwear

✅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. ✅Avoiding sleeping with pets in the client's bed 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. ✅Showering the night before and the morning of surgery with chlorhexidine ✅Sleeping on clean linen wearing clean nightwear 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. Chapter 46 - Concepts of Care for Patients With Arthritis and Total Joint Arthroplasty

3 of 11 The nurse is completing an admission assessment on a client scheduled for arthroscopic knee surgery. Which information will be most essential for the nurse to report to the health care provider? Allergy to shellfish and iodine Knee pain at a level of 9 (0-10 scale) Previous surgery on the other knee Warm, red, and swollen knee

✅Warm, red, and swollen knee Findings such as swelling, heat, and redness may indicate infection in the knee joint and is most essential for the nurse to report to the health care provider. These findings will help the health care provider determine whether there may be a need to cancel the procedure. Having knee pain before surgery is not unexpected but will not affect whether the client will have surgery. Having previous surgery on the other knee does not preclude the client from having this surgery. Chapter 44 - Assessment of the Musculoskeletal System iggy

1 of 16 The nurse is developing a health teaching plan for a client diagnosed with osteoarthritis (OA). The nurse includes which instruction in the teaching plan? Take up knitting to slow down joint degeneration. Eat at least 2 yogurts every day. Wear supportive shoes at all times. Begin a jogging or running program.

✅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. Chapter 46 - Concepts of Care for Patients With Arthritis and Total Joint Arthroplasty