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A home health care nurse is visiting a client discharged home after a hip replacement. The client is still using a walker. What safety precautions can the nurse recommend to the client? (Select all that apply.)
- A. Buy and install an elevated toilet seat
- B. Install grab bars in the shower and by the toilet
- C. Step into the bathtub with the affected leg first
- D. Remove throw rugs throughout the house
- E. Use a shower chair
Correct Answer: A,B,D,E
Rationale: Buying and installing an elevated toilet seat, installing grab bars, removing throw rugs, and using a shower chair will all promote safety for this client. The client is still on partial weight-bearing, so stepping into the bathtub with the affected leg first is not appropriate.
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A client has newly diagnosed systemic lupus erythematosus (SLE). What instruction by the nurse is most important?
- A. Be sure you get enough sleep at night
- B. Eat plenty of high-protein, high-iron foods
- C. Notify your provider at once if you get a fever
- D. Weigh yourself every day on your home scale
Correct Answer: C
Rationale: A fever is a classic sign of a lupus flare and should be reported immediately. Rest and nutrition are important but do not take priority over teaching the client what to do if they develop an elevated temperature.
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.
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 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 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.