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A nurse is assisting with the plan of care for a client who has osteoarthritis. The client reports knee stiffness upon ambulation. Which of the following interventions should the nurse include in the plan of care?
- A. Apply moist heat prior to ambulation.
- B. Delay ambulation until the next day
- C. Use a continuous passive motion machine
- D. Rest in a soft chair
- E. Apply cold packs.
- F. Increase weight-bearing exercise.
- G. Avoid all movement.
Correct Answer: A
Rationale: Moist heat reduces stiffness and improves mobility in osteoarthritis.
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A nurse is reviewing a client's medical history to identify risk factors for osteoporosis. The nurse should identify that which of the following findings is a risk factor for developing steps
- A. Age 45 years
- B. Regular aerobic exercise
- C. Uses NSAIDS for pain relief
- D. Smokes cigarettes
Correct Answer: D
Rationale: Smoking increases osteoporosis risk by decreasing bone mass. The other options do not directly contribute to osteoporosis development.
A nurse is caring for a client who has a distal radius fracture with a short arm cast applied. Which of the following actions should the nurse take?
- A. Use a hair dryer to blow hot air into the cast to relieve itching.
- B. Perform neurovascular checks of the affected extremity every 2 hr.
- C. Position the fractured arm below the level of the client's heart.
- D. Immobilize the client's fingers using a hand splint.
Correct Answer: B
Rationale: Neurovascular checks every 2 hours assess circulation and nerve function, critical after cast application. Hot air can burn, elevation reduces swelling, and finger immobilization isn't standard unless specified.
A nurse is assisting in the care of the client who is postoperative following a fasciotomy. The nurse is reviewing the client's electronic medical record (EMR). Which of the following statements in the EMR indicate the client's condition is improving since implementing interventions?
- A. Client reports pain as a 4 on a scale of 0 to 10.
- B. Bilateral breath sounds clear and present throughout.
- C. Right leg warm to touch, incision dressing dry and intact.
- D. Wound drain negative-pressure system, draining small amount of serosanguinous fluid.
Correct Answer: C
Rationale: Fasciotomy relieves compartment syndrome pressure, so improvement hinges on limb perfusion and wound stability. Right leg warm to touch with a dry, intact dressing indicates good circulation and no excessive bleeding or infection key recovery signs post-fasciotomy. Pain at 4/10 may suggest improvement if previously higher, but it's subjective and less specific without baseline comparison. Clear breath sounds are reassuring but unrelated to the surgical site unless pulmonary complications were a concern, not implied here. Small serosanguinous drainage is normal initially, but small' alone doesn't confirm progress without prior volume context. Warmth and a stable dressing directly reflect surgical success restored blood flow and wound healing making it the strongest EMR indicator of improvement, per postoperative assessment priorities.
A nurse is reinforcing teaching for a client who was admitted with an exacerbation of COPD. Which of the following should the nurse include in the client teaching?
- A. You should consume small, frequent meals each day.
- B. You should decrease your caloric intake by 200 calories per day.
- C. You should increase your oxygen to 5 liters per minute if you have shortness of breath.
- D. You should discontinue your prednisone when your symptoms improve.
Correct Answer: A
Rationale: Small, frequent meals reduce diaphragm pressure and breathing effort in COPD. Caloric reduction isn't advised, oxygen adjustments need orders, and prednisone requires tapering.
A nurse is caring for a client who is postoperative following the placement of a colostomy. Which of the following findings indicates the colostomy is functioning properly?
- A. Passing of flatus
- B. Stoma is pinkish-red
- C. Tolerating a clear liquid diet
- D. Absent bowel sounds
Correct Answer: A
Rationale: Passing flatus indicates the colostomy is functioning by expelling gas, a normal postoperative sign. Pink stoma and diet tolerance are positive but not definitive, and absent sounds suggest ileus.