Nokea
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.
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The nursing student studying rheumatoid arthritis (RA) learns which facts about the disease? (Select all that apply.)
- A. It affects single joints only
- B. Antibodies lead to inflammation
- C. It consists of an autoimmune process
- D. Morning stiffness is common
- E. Permanent damage is inevitable
Correct Answer: B,C
Rationale: RA is a chronic autoimmune systemic inflammatory disorder leading to arthritis-type symptoms in the joints and other symptoms that can be seen outside the joints. Antibodies are created that lead to inflammation. Permanent damage is not inevitable with aggressive, early treatment.
A nurse works with several clients who have gout. Which types of gout and their drug treatments are correctly matched? (Select all that apply.)
- A. Allopurinol (Zyloprim): Acute gout
- B. Colchicine (Colcrys): Acute gout
- C. Febuxostat (Uloric): Chronic gout
- D. Probenecid: Chronic gout
- E. Indomethacin: Acute gout
Correct Answer: B,C,D,E
Rationale: Colchicine and indomethacin are used for acute gout attacks. Febuxostat and probenecid are used for chronic gout management. Allopurinol is also used for chronic gout, not acute gout.
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 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.
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.