Nokea
The nurse is teaching a client with gout dietary strategies to prevent exacerbations or other problems. Which statement by the nurse is most appropriate?
- A. Drink 1 to 2 liters of water daily
- B. Have 10 to 12 ounces of juice daily
- C. Liver is a good source of iron
- D. Avoid alcohol consumption
Correct Answer: A
Rationale: Kidney stones are common in clients with gout, so drinking plenty of water will help prevent this from occurring. Citrus juice is high in acid, which can help prevent the formation of stones, but the value of this recommendation is not clear. Clients with gout should not consume organ meats or fish with bones, such as sardines.
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The nursing student studying rheumatoid arthritis (RA) learns which facts about the disease? (Select all that apply.)
- A. It affects single joints only
- B. Antibodies lead to inflammation
- C. It consists of an autoimmune process
- D. Morning stiffness is common
- E. Permanent damage is inevitable
Correct Answer: B,C
Rationale: RA is a chronic autoimmune systemic inflammatory disorder leading to arthritis-type symptoms in the joints and other symptoms that can be seen outside the joints. Antibodies are created that lead to inflammation. Permanent damage is not inevitable with aggressive, early treatment.
A client is receiving an opioid analgesic for postoperative pain after joint replacement surgery. The client is also on celecoxib for arthritis in other joints. What action by the nurse is most appropriate?
- A. Consult the provider about continuing celecoxib
- B. Discontinue the opioid analgesic
- C. Increase the dose of celecoxib
- D. Monitor for gastrointestinal bleeding
Correct Answer: A
Rationale: The nurse should consult the provider about continuing celecoxib while the client is in the hospital, as it can help with postoperative pain and arthritis management.
The nurse working in the orthopedic clinic knows that a client with which factor has an absolute contraindication for having a total joint replacement?
- A. Needs multiple dental fillings
- B. Over age 85
- C. Severe osteoporosis
- D. Urinary tract infection
Correct Answer: C
Rationale: Osteoporosis is a contraindication to joint replacement because the bones have a high risk of shattering as the new prosthesis is implanted. The client who needs fillings should have them done prior to the surgery. Age greater than 85 is not an absolute contraindication. A urinary tract infection can be treated prior to surgery.
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.
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.