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How should the nurse explain the purpose of methotrexate in treating a child with juvenile arthritis?
- A. Improves functional ability
- B. Controls the febrile response
- C. Minimizes the effects of uveitis
- D. Decreases the inflammatory response
Correct Answer: D
Rationale: Methotrexate is a disease-modifying antirheumatic drug that reduces inflammation in juvenile arthritis.
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The client is being evaluated for osteoporosis. Which diagnostic test is the most accurate when diagnosing osteoporosis?
- A. X-ray of the femur.
- B. Serum alkaline phosphatase.
- C. Dual-energy x-ray absorptiometry (DEXA).
- D. Serum bone Gla-protein test.
Correct Answer: C
Rationale: DEXA is the gold standard for osteoporosis diagnosis, measuring bone mineral density. X-rays detect fractures, alkaline phosphatase is nonspecific, and bone Gla-protein is not diagnostic.
The nurse starting the shift is determining priorities for the day. Prioritize the order that the nurse should plan to assess the four clients.
- A. Client who had a left BKA and has left foot pain of 6 on a 0 to 10 scale
- B. Client who has a right lower leg cast whose right foot is cold to the touch
- C. Client who had a THR and 200-mL wound drain output during the past 8 hours
- D. Client who had a spinal fusion and has not voided since the urinary catheter removal 4 hours ago
Correct Answer: B,A,D,C
Rationale: B. The client who has a right lower leg cast whose right foot is cold to the touch should be assessed first. The data could indicate compartment syndrome, which is an emergent condition. A. The client who had a left BKA and has left foot pain of 6 on a 0 to 10 scale should be assessed second because pain is a priority in a postoperative client and should be addressed in a timely manner, but this is not an emergent situation. D. The client who had a spinal fusion and has not voided since the urinary catheter removal 4 hours ago should be assessed third for the presence of urinary retention. Usually the client should void within 6 hours after a urinary catheter has been removed. C. The client who had a THR and 200-mL wound drain output during the past 8 hours should be assessed last. This amount of output is a common finding following a THR due to the vascular nature of the operative site.
The client has an external fixator for reduction of a tibia fracture. The nurse is evaluating the client's effectiveness in ambulating with crutches. Place an X on each of the three areas where the client should be bearing weight When crutch walking.
- A. The client should be bearing weight on the hand grips when bringing legs forward. When moving crutches, the weight should be borne on the unaffected leg.
Correct Answer: image
Rationale: The client should be bearing weight on the hand grips when bringing legs forward and on the unaffected leg when moving crutches to ensure proper crutch-walking technique and stability.
The nursing student is caring for the client who had a right TKR 1 day ago. Which action by the student requires the nurse to intervene?
- A. Hands the client the control for the continuous passive motion (CPM) machine
- B. Offers the client an analgesic when pain is rated at 3 on a 0 to 10 scale
- C. Repositions the leg to insert an abductor pillow between the client's legs
- D. Places an ice pack wrapped within a towel on the client's operative knee
Correct Answer: C
Rationale: C. Attempting to insert an abductor pillow may cause knee misalignment. An abductor pillow may be used for the client following a THR.
When implementing the care plan, the nurse should encourage the major intake of fluids at which time of the day?
- A. Before bedtime
- B. Early evening
- C. In the morning
- D. Midafternoon
Correct Answer: C
Rationale: Morning fluid intake promotes hydration and uric acid excretion throughout the day.