Nokea
The nurse is preparing a client for a surgical procedure that will allow visualization of the extent of joint damage of the knee for a client with rheumatoid arthritis and also obtain a sample of synovial fluid. What procedure will the nurse prepare the client for?
- A. Open reduction
- B. Needle aspiration
- C. Arthroplasty
- D. Arthroscopy
Correct Answer: D
Rationale: Arthroscopic examination may be carried out to visualize the extent of joint damage as well as to obtain a sample of synovial fluid. An open reduction would be used for the treatment of a fracture. Needle aspiration will not allow visualization of the joint damage but will allow obtaining the sample of synovial fluid. Arthroplasty is the restructure of the joint surface after diagnosis is made.
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In osteoporosis, which of the following is the most common complication?
- A. Diabetes
- B. Hypertension
- C. Compression fractures of the vertebrae
- D. Cardiac disease
Correct Answer: C
Rationale: In osteoporosis, loss of bone substance exceeds bone formation. The total bone mass and density is reduced, resulting in bones that become progressively porous, brittle, and fragile. Compression fractures of the vertebrae are common. Diabetes, hypertension, and cardiac disease may occur in response to the aging process but are not the result of osteoporosis.
The nurse is assisting a client with removing shoes prior to an examination and observes that the client has a flexion deformity of several toes on both feet of the proximal interphalangeal (PIP) joints. What can the nurse encourage the client to do?
- A. Bind the toes so that they will straighten.
- B. Do active range of motion on the toes.
- C. Have surgery to fix them.
- D. Wear properly fitting shoes.
Correct Answer: D
Rationale: Hammer toe is a flexion deformity of the PIP joint and may involve several toes and may result from wearing poorly fitting shoes. They will not straighten by binding the toes or doing active range of motion exercises. Surgery is an option but should be discussed with an orthopedic surgeon or podiatrist.
A client with ankylosing spondylitis has a stooped position and is being positioned in the bed prior to the nurse taking vital signs. The nurse listens to the client's lungs after positioning. What finding related to the client's condition may the nurse hear when listening to lung sounds?
- A. Crackles in the bases
- B. Pericardial friction rub
- C. Lung sounds may be diminished in the apical area.
- D. Rhonchi
Correct Answer: C
Rationale: Lung sounds may be reduced, especially in the apical area. The nurse would not hear rhonchi, crackles, or a pericardial friction rub unless the client had underlying cardiac or respiratory disorders.
A client is receiving treatment for rheumatoid arthritis but reports being allergic to eggs. What medication would the client be unable to receive?
- A. Methotrexate (Rheumatrex)
- B. Synvisc
- C. Anakinra (Kineret)
- D. Prednisone
Correct Answer: B
Rationale: Clients allergic to eggs should not receive Synvisc injections because they will also be allergic to this. The other medications can be taken with an egg allergy.
The nurse is planning care in the home for a client with rheumatoid arthritis. What instruction(s) should the nurse include in the plan of care? Select all that apply.
- A. Collaborate with occupational therapists for specialized equipment.
- B. Identify the exercise regimen planned by physical therapist.
- C. Provide nursing assistance for ADLs.
- D. Teach the nursing assistant to allow extra time in the evening for hygiene or other procedures.
- E. Ensure the home environment is safe.
Correct Answer: A,B,C,E
Rationale: The nurse should collaborate with occupational therapists for specialized equipment, identify the exercise regimen planned by physical therapist, provide nursing assistance for ADLs, and ensure the home environment is safe. The nurse should teach the nursing assistant to allow extra time in the morning, not the evening, for hygiene or other procedures.