Nokea
A client diagnosed with degenerative joint disease of the fingers reports now having bumps on the fingers that do not hurt. The nurse observes bony nodules on the distal interphalangeal joints. What type of 'bumps' does the nurse understand these are?
- A. Rheumatoid nodules
- B. Tophi
- C. Bouchard nodes
- D. Heberden nodes
Correct Answer: D
Rationale: DJD affects the hands; the fingers frequently develop painless bony nodules on the dorsolateral surface of the interphalangeal joints. Heberden nodes are bony enlargement of the distal interphalangeal joints. Bouchard nodes are bony enlargement of the proximal interphalangeal joints. Rheumatoid nodules are associated with rheumatoid arthritis. Tophi occur with gout and elevated uric acid levels.
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A client with degenerative joint disease asks the nurse for suggestions to avoid unusual stress on the joints. Which suggestion would be appropriate?
- A. Keep shifting weight from one foot to the other.
- B. Perform aerobic exercises.
- C. Maintain complete bed rest.
- D. Maintain good posture.
Correct Answer: D
Rationale: The nurse needs to remind the client with degenerative joint disease to maintain good posture to avoid unusual stress on a joint. Although the client need not maintain complete bed rest, performing aerobic exercises is not advisable because it may place undue stress on the joint worsening the condition. Shifting weight from one foot to the other does not help avoid unusual stress on a joint.
A client suffered a significant ankle fracture several months ago. Which indicator would the nurse use to determine that the client is exhibiting signs and symptoms of chronic osteomyelitis?
- A. High fever
- B. Persistent draining sinus
- C. Rapid pulse
- D. Tenderness over the affected area
Correct Answer: B
Rationale: Persistent draining sinus indicates a chronic infection in a client with osteomyelitis. This is the symptom the nurse would use to differentiate between an acute and chronic infection. High fever, rapid pulse, and tenderness or pain over the affected area is evidence of an acute infection.
A client with osteoporosis is prescribed a selective estrogen receptor modifier (SERM) as treatment. The nurse would identify which drug as belonging to this class?
- A. Alendronate (Fosamax)
- B. Calcium gluconate
- C. Tamoxifen (Nolvadex)
- D. Raloxifene (Evista)
Correct Answer: D
Rationale: An example of a selective estrogen receptor modifier (SERM) is raloxifene (Evista). Alendronate is a bisphosphonate; calcium gluconate is an oral calcium preparation; tamoxifen is an antiestrogen agent.
The nurse is reviewing the diagnostic test findings of a client with rheumatoid arthritis. What would the nurse expect to find?
- A. Increased red blood cell count
- B. Increased C4 complement
- C. Elevated erythrocyte sedimentation rate
- D. Increased albumin levels
Correct Answer: C
Rationale: The erythrocyte sedimentation rate (ESR) may be elevated, particularly as the disease progresses. ESR shows inflammation associated with RA. Red blood cell count and C4 complement component are decreased. Serum protein electrophoresis may disclose increased levels of gamma and alpha globulin but decreased albumin.
A client is taking large amounts of salicylates for the treatment of bursitis of the left shoulder. The client should be aware to report which symptoms of salicylism?
- A. Ringing in the ears
- B. Diarrhea
- C. Dry hacking cough
- D. Dry eyes
Correct Answer: A
Rationale: Signs of salicylate toxicity include headache, nausea, vomiting, tinnitus, increased pulse and respiratory rate, fever, mental confusion, and drowsiness. Dry hacking cough, diarrhea, and dry eyes are not symptoms of salicylate toxicity.