Nokea
A client in the orthopedic clinic has a self-reported history of osteoarthritis. The client reports a low-grade fever that started when the weather changed and several joints started acting up, especially both hips and knees. What action by the nurse is best?
- A. Assess for the presence of subcutaneous nodules or Baker's cysts
- B. Inspect the client's feet and hands for podagra and tophi on fingers and toes
- C. Assess for the correlation of osteoarthritis to weather changes
- D. Reassure the client that the problems will fade when the weather changes again
Correct Answer: A
Rationale: Osteoarthritis is not a systemic disease, nor does it present bilaterally. These are manifestations of rheumatoid arthritis. The nurse should assess for other manifestations of this disorder, including subcutaneous nodules and Baker's cysts. Inspecting for podagra and tophi is more relevant for gout. Reassuring the client about weather changes is inaccurate.
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The clinic nurse assesses a client with diabetes during a checkup. The client also has osteoarthritis (OA). The nurse notes the client's 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. You're still taking your diabetic medication, right?
Correct Answer: B
Rationale: 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.
After a total knee replacement, a client is on the postoperative nursing unit with a continuous femoral nerve block. On assessment, the nurse notes the client's pulses are 2+/4 bilaterally, the skin is pale pink, warm, and dry, and the client is unable to dorsiflex or plantarflex the affected foot. What action does the nurse take?
- A. Document the findings and monitor as prescribed
- B. Increase the frequency of monitoring the client
- C. Notify the surgeon or anesthesia provider immediately
- D. Palpate the client's bladder to perform a bladder scan
Correct Answer: C
Rationale: With the femoral nerve block, the client should still be able to dorsiflex and plantarflex the affected foot. Since this client has an abnormal finding, the nurse should notify either the surgeon or the anesthesia provider immediately. Documentation is the last priority. Increasing the frequency of assessment may be a good idea, but first the nurse must notify the appropriate person. Palpating the bladder is not related.
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.
A client with fibromyalgia is in the hospital for an unrelated issue. The client reports that sleep, which is always difficult, is even harder now. What actions by the nurse are most appropriate? (Select all that apply.)
- A. Allow uninterrupted rest time
- B. Adhere to the client's usual bedtime routine
- C. Limit noise and light
- D. Offer a strong sleeping pill
- E. Provide a warm shower
Correct Answer: A,B,C,E
Rationale: Clients with fibromyalgia often have sleep disturbances, which can be exacerbated by the hospital environment. Allowing uninterrupted rest time, adhering to the client's usual bedtime routine, limiting noise and light, and offering a warm shower can help. A strong sleeping pill should be a last resort.
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. Teach the client about foods high in protein and iron
- D. Monitor the client's hemoglobin levels
Correct Answer: B
Rationale: The preoperative nurse should ensure that all valid consents are on the chart, including one for blood transfusions if this may be needed. This is critical for legal and ethical reasons.