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.
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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.
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.
After a total knee replacement, a client is on the postoperative nursing unit with a continuous femoral nerve block. On assessment, the nurse notes the client's pulses are 2+/4 bilaterally, the skin is pale pink, warm, and dry, and the client is unable to dorsiflex or plantarflex the affected foot. What action does the nurse take?
- A. Document the findings and monitor as prescribed
- B. Increase the frequency of monitoring the client
- C. Notify the surgeon or anesthesia provider immediately
- D. Palpate the client's bladder to perform a bladder scan
Correct Answer: C
Rationale: With the femoral nerve block, the client should still be able to dorsiflex and plantarflex the affected foot. Since this client has an abnormal finding, the nurse should notify either the surgeon or the anesthesia provider immediately. Documentation is the last priority. Increasing the frequency of assessment may be a good idea, but first the nurse must notify the appropriate person. Palpating the bladder is not related.
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.
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.
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