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A client is on the postoperative unit after a total hip replacement. The client reports a sudden onset of shortness of breath, chest pain, and coughing. What action by the nurse is best?
- A. Assess neurovascular status of 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
Correct Answer: A
Rationale: 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 this client.
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A nurse in the family clinic is teaching a client newly diagnosed with osteoarthritis (OA) about drugs used to treat the disease. For which medication does the nurse plan primary teaching?
- A. Acetaminophen
- B. Cyclobenzaprine hydrochloride (Flexeril)
- C. Hydrocortisone (Hylan)
- D. Ibuprofen
Correct Answer: A
Rationale: All of the drugs are appropriate to treat OA. However, the first-line drug is acetaminophen. Cyclobenzaprine is a muscle relaxant given to treat muscle spasms. Hydrocortisone is a synthetic joint fluid implant. Ibuprofen is a non-steroidal anti-inflammatory drug.
A nurse is caring for a client with systemic sclerosis. The client's facial skin is very tight, limiting the ability to open the mouth. Besides a consultation with a registered dietitian for appropriate nutrition, what other consultation should the nurse facilitate?
- A. Dentist
- B. Massage therapist
- C. Occupational therapy
- D. Physical therapy
Correct Answer: A
Rationale: With limited ability to open the mouth, dental hygiene may be lacking. The nurse should encourage the client to see a dentist. The other referrals are not related to the mouth.
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.
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 has a possible connective tissue disease and the nurse is reviewing the client's laboratory values. Which laboratory values and their related connective tissue diseases (CTDs) are correctly matched? (Select all that apply.)
- A. Elevated antinuclear antibody (ANA): Normal value: no connective tissue disease
- B. Elevated sedimentation rate: Rheumatoid arthritis
- C. Elevated albumin: Indicative only of rheumatoid deficit
- D. Positive human leukocyte antigen B27 (HLA-B27): Reiter's syndrome or ankylosing spondylitis
- E. Positive rheumatoid factor: Possible kidney disease
Correct Answer: D,E
Rationale: The HLA-B27 is diagnostic for Reiter's syndrome or ankylosing spondylitis. A positive rheumatoid factor can be seen in autoimmune CTDs, kidney and liver disease, or leukemia.