Nokea
A nurse is teaching a female client with rheumatoid arthritis (RA) about taking methotrexate (MTX) for disease control. What information does the nurse include? (Select all that apply.)
- A. Avoid acetaminophen or over-the-counter medication
- B. It may take several weeks to become effective
- C. Pregnancy and breast-feeding are not affected by MTX
- D. You may find that folic acid, a B vitamin, reduces side effects
- E. Avoid crowds and sick people
Correct Answer: A,B,D,E
Rationale: MTX is a disease-modifying antirheumatic drug and is used as a first-line drug for RA. MTX can cause liver toxicity, so the client should be advised to avoid medications that contain acetaminophen. It may take weeks to effectively treat RA. MTX can cause immunosuppression, so avoiding sick people and crowds is important. Folic acid helps reduce side effects for some people. Pregnancy and breast-feeding are contraindicated while on this drug.
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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.
A client with fibromyalgia is in the hospital for an unrelated issue. The client reports that sleep, which is always difficult, is even harder now. What actions by the nurse are most appropriate? (Select all that apply.)
- A. Allow uninterrupted rest time
- B. Adhere to the client's usual bedtime routine
- C. Limit noise and light
- D. Offer a strong sleeping pill
- E. Provide a warm shower
Correct Answer: A,B,C,E
Rationale: Clients with fibromyalgia often have sleep disturbances, which can be exacerbated by the hospital environment. Allowing uninterrupted rest time, adhering to the client's usual bedtime routine, limiting noise and light, and offering a warm shower can help. A strong sleeping pill should be a last resort.
A client comes to the family medicine clinic and reports joint pain and stiffness. The nurse is asked to assess the client for Heberden's nodules. What assessment technique is correct?
- A. Inspect the client's distal finger joints
- B. Palpate the client's upper body lymph nodes
- C. Assess the client's range of motion
- D. Perform a musculoskeletal strength test
Correct Answer: A
Rationale: Heberden's nodules are bony swellings at the distal interphalangeal joints, commonly associated with osteoarthritis. Inspecting the distal finger joints is the correct assessment technique.
A nurse works in the rheumatology clinic and sees clients with rheumatoid arthritis (RA). Which client should the nurse see first?
- A. Client who reports jaw pain when eating
- B. Client with a red, hot, swollen right wrist
- C. Client who has a puffy-looking area behind the knee
- D. Client with a worse joint deformity since the last visit
Correct Answer: B
Rationale: All of the options are possible manifestations of RA. However, the presence of one joint that is much redder, hotter, or more swollen than other joints may indicate infection. The nurse needs to see this client first.
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.