Nokea
A client comes to the family medicine clinic and reports joint pain and stiffness. The nurse is asked to assess the client for Heberden's nodules. What assessment technique is correct?
- A. Inspect the client's distal finger joints
- B. Palpate the client's upper body lymph nodes
- C. Assess the client's range of motion
- D. Perform a musculoskeletal strength test
Correct Answer: A
Rationale: Heberden's nodules are bony swellings at the distal interphalangeal joints, commonly associated with osteoarthritis. Inspecting the distal finger joints is the correct assessment technique.
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The nurse working in the orthopedic clinic knows that a client with which factor has an absolute contraindication for having a total joint replacement?
- A. Needs multiple dental fillings
- B. Over age 85
- C. Severe osteoporosis
- D. Urinary tract infection
Correct Answer: C
Rationale: 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.
A client who has had systemic lupus erythematosus (SLE) for many years is in the clinic reporting hip pain with ambulation. Which action by the nurse is best?
- A. Assess if the client has been taking steroids
- B. Facilitate a consultation with physical therapy
- C. Measure the range of motion in both hips
- D. Notify the health care provider immediately
Correct Answer: A
Rationale: Steroid use is common in clients with SLE and can lead to osteonecrosis (bone necrosis). The nurse should determine if the client has been taking a steroid. Physical therapy may be beneficial, but there is not enough information about the client yet. Measuring range of motion is best done by the physical therapist. Notifying the provider immediately is not warranted.
A nurse is teaching a client with rheumatoid arthritis (RA) who is prescribed etanercept (Enbrel). What information is most important for the nurse to teach this client?
- A. Administer the medication via subcutaneous injection twice a week
- B. Use heat on the injection site to reduce pain
- C. Avoid large crowds or people who are ill
- D. Monitor for signs of infection daily
Correct Answer: A
Rationale: Etanercept is given as a subcutaneous injection twice a week. The nurse should teach the client how to self-administer the medication. The other options are not appropriate for etanercept.
A client has been diagnosed with fibromyalgia syndrome but does not want to take the prescribed medication. What nonpharmacological measures can the nurse suggest to help manage this condition? (Select all that apply.)
- A. Acupuncture
- B. Breathing exercises
- C. Supplements
- D. Tai chi
- E. Vigorous aerobics
Correct Answer: A,B,D
Rationale: There are many nonpharmacologic means for controlling the symptoms of fibromyalgia, including acupuncture, breathing exercises, and tai chi. Vigorous aerobics may exacerbate symptoms, and supplements are not generally recommended without specific deficiencies.
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 client's condition. What action by the nurse is best?
- A. Assess the client's culture more thoroughly
- B. Assess options for performing duties
- C. Suggest the client attend a community meeting
- D. Suggest the client give up the role of elder
Correct Answer: A
Rationale: The nurse needs a more thorough understanding of the client's 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.