MS UNIT 6: EXAM 11

Which statement by a patient with discomfort from a bunion indicates to the nurse that more teaching is needed?

"I can only wear sandals, no closed-toe shoes."

The nurse instructs a patient who has osteosarcoma of the tibia about a scheduled above-the-knee amputation. Which patient statement indicates to the nurse that additional teaching is needed?

"I did not have this bone cancer until my leg broke a week ago."

The nurse should determine additional instruction is needed when a patient diagnosed with scleroderma makes which statement?

"I should lie down for an hour after each meal."

A patient is receiving IV antibiotics at home to treat chronic osteomyelitis of the left femur. Which statement by the patient should indicate to the nurse the need for additional teaching related to health maintenance?

"I think my left foot is starting to droop down."

A patient whose employment requires frequent lifting has a history of chronic back pain. After the nurse has taught the patient about correct body mechanics, which patient statement indicates the teaching has been effective?

"I will begin doing exercises to strengthen and support my back."

After teaching a 28-yr-old with fibromyalgia about the disease, which patient statement does the nurse determines indicates a good understanding of effective self-management?

"I will need to stop drinking so much coffee and soda."

The nurse teaches a patient with osteoarthritis (OA) of the hip about how to manage the OA. Which patient statement indicates to the nurse a need for additional teaching?

"I will take 1 gram of acetaminophen (Tylenol) every 4 hours."

Which statement by a patient with systemic lupus erythematosus (SLE) indicates the patient understands the nurse's teaching about the condition?

"I will use sunscreen when I am outside."

When the nurse brings medications to a patient with rheumatoid arthritis, the patient refuses the prescribed methotrexate. The patient tells the nurse, "My arthritis isn't that bad yet. The side effects of methotrexate are worse than the arthritis." What is the most appropriate response by the nurse?

"It is important to start methotrexate early to decrease the extent of joint damage."

A patient has recently been diagnosed with rheumatoid arthritis (RA) The patient, who has two school-age children, tells the nurse that home life is very stressful. Which initial response should the nurse make?

"Tell me more about the situations that are causing you stress."

A patient with osteomyelitis is to receive vancomycin (Vancocin) 500 mg IV every 6 hours. The vancomycin is diluted in 100 mL of normal saline and needs to be administered over 1 hour. The nurse should set the IV pump to deliver how many milliliters per minute? (Round to the nearest hundredth.)

1.67 mL/min

Which patient seen by the nurse in the outpatient clinic is most likely to need teaching about ways to reduce the risk for osteoarthritis (OA)?

A 56-yr-old woman who works on an automotive assembly line

Which information should the nurse include when teaching a patient with newly diagnosed systemic exertion intolerance disease (SEID) about self-management?

A gradual increase in daily exercise may help decrease fatigue.

How should the nurse suggest that a patient recently diagnosed with rheumatoid arthritis (RA) plan to start each day?

A warm bath followed by a short rest

The health care provider has prescribed the following interventions for a patient who is taking azathioprine (Imuran) for systemic lupus erythematosus. Which order should the nurse question?

Administer varicella vaccine.

A new clinic patient with joint swelling and pain is having diagnostic tests. Which test should the nurse identify as specific to systemic lupus erythematosus?

Anti-Smith antibody (Anti-Sm)

Which information should the nurse include when preparing teaching materials for a patient who has an exacerbation of rheumatoid arthritis?

Applying cold packs before exercise may decrease joint pain

Which action should the nurse take first when a patient is seen in the outpatient clinic with neck pain?

Ask about numbness or tingling of the hands and arms.

The nurse notices a circular lesion with a red border and clear center on the arm of a patient who is in the clinic reporting chills and muscle aches. Which action should the nurse take to follow up on that finding?

Ask the patient about recent outdoor activities.

A patient being seen in the clinic has rheumatoid nodules on the elbows. Which action should the nurse take?

Assess the nodules for skin breakdown or infection.

What action should the nurse complete before administering alendronate (Fosamax) to a patient with osteoporosis?

Assist the patient to sit up at the bedside.

A patient with muscular dystrophy is hospitalized with pneumonia. Which nursing action should the nurse include in the plan of care?

Assist the patient with ambulation.

What suggestion should the nurse make to a group of women with rheumatoid arthritis (RA) about managing activities of daily living?

Avoid activities requiring repetitive use of the same muscles and joints.

A patient with gout has a new prescription for losartan (Cozaar). What should the nurse plan to monitor?

Blood pressure

Which finding for a patient who is taking hydroxychloroquine (Plaquenil) to treat rheumatoid arthritis should the nurse identify as a likely adverse effect of the medication?

Blurred vision

Which laboratory result should the nurse monitor to determine if prednisone has been effective for a patient who has an acute exacerbation of rheumatoid arthritis?

C-reactive protein

A 54-yr-old woman who recently reached menopause and has a family history of osteoporosis is diagnosed with osteopenia. Which information should the nurse explain to the patient?

Calcium loss from bones can be slowed by increasing calcium intake and weight-bearing exercise.

The nurse should anticipate the need to teach a patient who has osteoarthritis (OA) about which medication?

Capsaicin cream (Zostrix)

A patient with psoriatic arthritis and back pain is receiving etanercept (Enbrel). Which finding is most important for the nurse to report to the health care provider?

Crackles are auscultated in the lung bases.

When reviewing the health record for a new patient with rheumatoid arthritis, the nurse reads that the patient has swan neck deformities. Which deformity should the nurse expect to observe when assessing the patient? (PICTURE)

D

Which finding should the nurse expect when assessing a patient who has osteoarthritis (OA) of the knee?

Discomfort with joint movement

Which information should the nurse include when teaching a patient with newly diagnosed ankylosing spondylitis (AS) about managing the condition?

Do daily deep-breathing exercises.

Which action for the care of a patient who has scleroderma can the registered nurse (RN) delegate to unlicensed assistive personnel (UAP)?

Document the patient's oral intake.

Which result for a patient with systemic lupus erythematosus (SLE) should the nurse identify as most important to communicate to the health care provider?

Elevated blood urea nitrogen (BUN)

Which action should the nurse include in the plan of care for a patient with a new diagnosis of rheumatoid arthritis (RA)?

Encourage the patient to take a nap in the afternoon.

Which information should the nurse include when teaching a patient with acute low back pain? (Select all that apply.)

Expect symptoms of acute low back pain to improve in a few weeks. Avoid activities that require twisting of the back or prolonged sitting. Use ibuprofen (Motrin, Advil) or acetaminophen (Tylenol) to relieve pain.

Anakinra (Kineret) is prescribed for a patient with rheumatoid arthritis (RA). What information should the nurse include in teaching the patient about this drug?

Giving subcutaneous injections.

Which action should the nurse include in the plan of care for a patient with newly diagnosed ankylosing spondylitis?

Have the patient sleep on their back with a flat pillow.

A patient is being discharged after 1 week of IV antibiotic therapy for acute osteomyelitis in the right leg. Which information should the nurse include in the discharge teaching?

How to monitor and care for a long-term IV catheter

A patient with acute osteomyelitis of the left femur is hospitalized for regional antibiotic irrigation. Which intervention should the nurse include in the initial plan of care?

Immobilization of the left leg

A patient has scleroderma manifested by CREST (calcinosis, Raynaud's phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia) syndrome. Which action should the nurse include in the plan of care?

Keep the environment warm and draft free.

What should the nurse include in the teaching plan for ae patient who has acute low back pain and muscle spasms?

Keep the head elevated slightly and flex the knees when resting in bed.

The nurse assesses a 78-yr-old who uses naproxen (Aleve) daily for hand and knee osteoarthritis management. Which information should the nurse discuss with the health care provider for an urgent change in the treatment plan?

Laboratory results indicate blood urea nitrogen (BUN) is elevated.

Which action included in the care of a patient after laminectomy can the nurse delegate to experienced unlicensed assistive personnel (UAP)?

Log roll the patient from side to side every 2 hours.

Which assessment finding for a 55-yr-old patient should alert the nurse to the presence of osteoporosis?

Loss of height

Which actions should the nurse include in the plan of care for a patient with metastatic bone cancer of the left femur? (Select all that apply.)

Monitor serum calcium. Explain the use of sustained-release opioids. Support the left leg when repositioning the patient. Assist family and patient as they discuss the prognosis.

Which menu choice by a patient with osteoporosis indicates the nurse's teaching about appropriate diet has been effective?

Oatmeal with skim milk and fruit yogurt

In which order should the nurse implement interventions prescribed for a patient admitted with acute osteomyelitis who has a temperature of 101.2° F? (Put a comma and a space between each answer choice [A, B, C, D].)

Obtain blood cultures from two sites. Administer dose of gentamicin 60 mg IV. Administer acetaminophen (Tylenol) now and every 4 hours PRN for fever. Send to radiology for computed tomography (CT) scan of right leg.

What should the nurse assess to evaluate the effectiveness of alendronate (Fosamax) therapy for a patient with Paget's disease?

Pain intensity

A nurse who works on the orthopedic unit has just received change-of-shift report. Which patient should the nurse assess first?

Patient who has not voided 8 hours after a laminectomy.

Which action should the nurse take when repositioning the patient who has just had a laminectomy and discectomy?

Place a pillow between the patient's legs and turn the entire body as a unit.

What finding should indicate to the nurse that colchicine has been effective for a patient with an acute attack of gout?

Reduced joint pain

Which action should the nurse take before administering gentamicin (Garamycin) to a patient with acute osteomyelitis?

Review the patient's serum creatinine results.

After laminectomy with a spinal fusion to treat a herniated disc, a patient reports numbness and tingling of the right lower leg. What action should the nurse take?

Review the preoperative assessment data in the health record.

A patient hospitalized with polymyositis has joint pain; erythematous facial rash; eyelid edema; and a weak, hoarse voice. What safety priority should the nurse identify for this patient?

Risk for aspiration

Which information from a patient's health history should the nurse identify as a risk factor for septic arthritis?

Sexually active with several partners

During assessment of the patient with fibromyalgia, the nurse should expect the patient to report which of the following? (Select all that apply.)

Sleep disturbances Multiple tender points Widespread bilateral, burning musculoskeletal pain

A 25-yr-old female patient with systemic lupus erythematosus (SLE) has a facial rash and alopecia. She tells the nurse, "I never leave my house because I hate the way I look." Which patient problem should the nurse plan to address?

Social isolation

A patient with rheumatoid arthritis (RA) tells the clinic nurse about having chronically dry eyes. Which action should the nurse take?

Suggest the patient use over-the-counter (OTC) artificial tears.

Which action should the nurse take when caring for a patient with osteomalacia?

Teach about the use of vitamin D supplements.

A patient has had surgical reduction of an open fracture of the right radius. Which assessment findings should the nurse report immediately to the health care provider?

Temperature 101.4° F (38.6° C)

A patient who had arthroscopic surgery of the right knee 7 days ago is admitted with a red, swollen, hot knee. Which assessment finding should the nurse report immediately to the health care provider?

The blood pressure is 86/50 mm Hg.

The nurse is assessing a patient with osteoarthritis who uses naproxen (Naproxyn) for pain management. Which assessment finding should the nurse recognize as likely to require a change in medication?

The patient has dark-colored stools.

A patient with dermatomyositis is receiving long-term prednisone therapy. Which assessment finding should the nurse report immediately to the health care provider?

The patient has painful hematuria.

A 29-yr-old woman is taking methotrexate to treat rheumatoid arthritis. Considering this treatment, which information should the nurse report to the health care provider?

The patient is trying to get pregnant before her disease becomes more severe.

The home health nurse is making a follow-up visit to a patient recently diagnosed with rheumatoid arthritis (RA). Which finding indicates to the nurse that additional patient teaching is needed?

The patient sleeps with two pillows under the head.

A patient with an acute attack of gout in the right great toe has a new prescription for probenecid. Which information about the patient's home routine should the nurse understand indicates a need for teaching regarding gout management?

The patient takes one aspirin a day to prevent angina.

Which assessment information should indicate to the nurse that a patient with an exacerbation of rheumatoid arthritis (RA) is experiencing a side effect of prednisone?

The patient's blood glucose is 165 mg/dL.

A patient is taking methotrexate to treat rheumatoid arthritis (RA). Which laboratory result is important for the nurse to communicate to the health care provider?

The white blood cell count is 1500/μL.

A patient with hypertension and gout has a red, painful right great toe. Which action should the nurse include in the plan of care for this patient?

Use a footboard to hold bedding away from the toe.

A patient reporting painful urination and knee pain is diagnosed with reactive arthritis. What long-term therapy should the nurse plan to explain to the patient?

doxycycline (Vibramycin)

A patient who takes multiple medications develops acute gout arthritis. Which medication should the nurse discuss with the health care provider before administering a prescribed dose?

hydrochlorothiazide.