Nokea
A nurse is discharging a client after a total hip replacement. What statement by the client indicates good understanding of discharge instructions?
- A. I can bend down to pick something up
- B. I no longer need to do my exercises
- C. I will not cross my legs when sitting
- D. I will avoid weight-bearing exercises
Correct Answer: C
Rationale: The client should avoid crossing their legs to prevent dislocation of the new hip joint. Bending down, stopping exercises, and avoiding weight-bearing exercises are not appropriate instructions for recovery.
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A client has rheumatoid arthritis that especially affects the hands. The client wants to finish quilting a baby blanket before the birth of her grandchild. What response by the nurse is best?
- A. Let's ask the provider about increasing your pain pills
- B. Hold ice bags against your hands before quilting
- C. Try a paraffin wax dip 20 minutes before you quilt
- D. You need to stop quilting before it destroys your fingers
Correct Answer: C
Rationale: Paraffin wax dips are beneficial for decreasing pain in arthritic hands and lead to increased mobility. The nurse can suggest this comfort measure.
A client with rheumatoid arthritis (RA) is on the postoperative nursing unit after having elective surgery. The client reports that the arm feels like pins and needles and that the neck is painful since returning from surgery. What action by the nurse is best?
- A. Assist the client to change positions
- B. Encourage range of motion of the neck
- C. Notify the provider immediately
- D. Provide pain medication as ordered
Correct Answer: C
Rationale: Clients with RA can have cervical joint involvement. This can lead to an emergent situation due to potential spinal cord compression. The nurse should notify the provider immediately to assess for this serious complication.
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 continuous passive motion (CPM) device after a total knee replacement. What action does the nurse delegate to the unlicensed assistive personnel (UAP) after the affected leg is placed in the machine while the client is in bed?
- A. Assess the distal circulation in 30 minutes
- B. Change the settings based on a range of motion
- C. Raise the lower siderail on the affected side
- D. Remind the client to do quad-setting exercises
Correct Answer: C
Rationale: Because the client's leg is strapped into the CPM, if it falls off the bed due to movement, the client's leg (and knee) could be injured. Raising the siderail prevents this. Assessment is a nursing responsibility. Only the surgeon, physical therapist, or specially trained technician adjust the CPM settings. Quad-setting exercises are not related to the CPM machine.
A client with rheumatoid arthritis (RA) is having difficulty completing activities of daily living (ADLs). What devices can the nurse suggest to increase the client's independence? (Select all that apply.)
- A. Grab bars
- B. Long-handled bath brushes
- C. Rocker-recliner
- D. Toothbrushes with built-up handles
- E. Wheelchair cushion
Correct Answer: A,B,D
Rationale: Grab bars, long-handled bath brushes, and toothbrushes with built-up handles all provide modifications for daily activities, making it easier for the client with RA to complete ADLs independently. The rocker-recliner and wheelchair cushion are comfort measures but do not help increase independence.