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A nurse is teaching a client with psoriatic arthritis about the medication golimumab (Simponi). What information is most important to include?
- A. Avoid large crowds or people who are ill
- B. Stay upright for 1 hour after taking this drug
- C. This drug may cause your hair to fall out
- D. You may double the dose if pain is severe
Correct Answer: A
Rationale: This drug has a Food and Drug Administration black box warning about opportunistic or other serious infections. Teach the client to avoid large crowds and people who are ill. The other instructions do not pertain to golimumab.
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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.
A client is getting out of bed into the chair for the first time after an uncemented hip replacement. What action by the nurse is most important?
- A. Have adequate help to transfer the client
- B. Provide brown socks to transfer the client
- C. Tell the client full weight bearing is allowed
- D. Use a footstool to elevate the client's leg
Correct Answer: A
Rationale: The client with an uncemented hip will be on toe-touch only right after surgery. The nurse should ensure adequate help to transfer the client while preventing falls. Slippery socks and elevating the leg are not appropriate.
The clinic nurse assesses a client with diabetes during a checkup. The client also has osteoarthritis (OA). The nurse notes the client's blood glucose readings have been elevated. What question by the nurse is most appropriate?
- A. Are you compliant with following the diabetic diet?
- B. Have you been taking glucosamine supplements?
- C. How much exercise do you really get each week?
- D. You're still taking your diabetic medication, right?
Correct Answer: B
Rationale: All of the topics are appropriate for a client whose blood glucose readings have been higher than usual. However, since this client also has OA, and glucosamine can increase blood glucose levels, the nurse should ask about its use. The other questions all have an element of nontherapeutic communication in them.
Which clinical manifestations are seen in clients with connective tissue diseases? (Select all that apply.)
- A. Dry, scaly skin rash: Systemic lupus erythematosus
- B. Esophageal motility problems: Systemic sclerosis
- C. Vasculitis leading to organ damage: Rheumatoid arthritis
- D. Foot drop and paresthesias: Rheumatoid arthritis
- E. Gout caused by hyperuricemia
Correct Answer: A,B,C,D,E
Rationale: A dry, scaly skin rash is common in SLE. Systemic sclerosis can lead to esophageal motility problems. Vasculitis leads to organ damage in rheumatoid arthritis. Foot drop and paresthesias occur in rheumatoid arthritis. Gout is caused by hyperuricemia.
The nurse is working with a client who has rheumatoid arthritis (RA). The nurse has identified the priority problem of poor body image for the client. What finding by the nurse indicates goals for this client problem are being met?
- A. Attends book club meetings regularly
- B. Takes medication as directed
- C. Uses assistive devices to protect joints
- D. Engages in regular physical therapy
Correct Answer: A
Rationale: All of the activities are appropriate for a client with RA. Clients who have a poor body image are often reluctant to appear in public, so attending public book club meetings indicates that goals for this client problem are being met.