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The nurse performs a home safety assessment for an older adult with rheumatoid arthritis. The nurse should make which recommendation to promote safety in the bathroom?
- A. Recommend using a handheld (adjustable) shower head
- B. Advise the client to lower the toilet seat to its lowest level
- C. Instruct the client to reduce bathroom lighting
- D. Recommend the use of towel racks for grab bars
Correct Answer: A
Rationale: A handheld shower head allows the client with rheumatoid arthritis to bathe more easily, accommodating limited mobility and joint stiffness. Lowering the toilet seat may make standing difficult, reduced lighting increases fall risk, and towel racks are not sturdy enough for support.
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The following scenario applies to the next 1 items
The nurse in the emergency department (ED) is caring for a 62-year-old female client.
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Triage Note
1211: The client was brought to the ED by her neighbor, who was concerned about her increasing pain and immobility. The client's neighbor reported that the client called her a few hours ago, asking her to go to the ED because of increasing pain and the inability to perform her activities of daily living. History of osteoporosis, hypertension, and gout. She reports that she recently started seeing a rheumatologist because of persistent fatigue, low-grade fevers, and lack of appetite. Vital signs: T 99.7° F (37.6° C), P 82, RR 16, BP 134/76, pulse oximetry reading 98% on room air. Pain rated 7/10 on the Numerical Rating Scale, which is described as throbbing of both feet, especially in her toes. She also reports having stiffness in her wrists and fingers that starts in the morning and persists throughout the day. Triage assessment: the client is alert and fully oriented to person, place, and situation. Peripheral pulses 2+. Clear lung sounds bilaterally. Swollen, errythemic toes that are warm and tender to touch. She does not recall her weight but reports significant weight loss over the past three months.
For each assessment finding below, click to specify if the finding is consistent with the disease process of osteoarthritis, acute gout flare, or rheumatoid arthritis. Each finding may support more than 1 disease process.
- A. Low-grade fever
- B. Weight loss
- C. Redness and warmth of the affected joint
- D. Morning joint stiffness in the wrists that lasts throughout the day
- E. Pain with movement in the affected joint
- F. Reduced range of motion in the affected joint
- G. Pain level
Correct Answer: A: Rheumatoid Arthritis, Acute Gout Flare, B: Rheumatoid Arthritis, C: Rheumatoid Arthritis, Acute Gout Flare, D: Rheumatoid Arthritis, E: Osteoarthritis, Rheumatoid Arthritis, Acute Gout Flare, F: Osteoarthritis, Rheumatoid Arthritis, Acute Gout Flare, G: Osteoarthritis, Rheumatoid Arthritis, Acute Gout Flare
Rationale: Seen in inflammatory conditions; not typical in osteoarthritis. Chronic systemic inflammation may lead to unintentional weight loss. Indicates joint inflammation; osteoarthritis does not usually present with warmth or redness. Stiffness >1 hour, especially in small joints, is classic for RA. Movement worsens pain in all these conditions, though the cause differs. All limit ROM due to stiffness, inflammation, or damage. Pain is a shared feature, though severity and timing vary.
Following the application of a fiberglass cast to treat the client's severe ankle sprain (i.e., Grade 3), a nurse performs client education. During this discussion, the client asks, 'How long will my cast take to dry?' Based on this type of cast, the nurse should respond:
- A. Eight hours
- B. 30 minutes
- C. At least 24 hours
- D. At least 48 hours
Correct Answer: B
Rationale: Fiberglass casts typically dry within 30 minutes to an hour, much faster than plaster casts, allowing for quick hardening and stability.
The nurse is caring for a client following a knee arthroscopy procedure. Which of the following assessments should be the priority?
- A. Wound and skin integrity
- B. Mobility assessment
- C. Skin and vascular assessment
- D. Circulation and sensation
Correct Answer: D
Rationale: Circulation and sensation are the priority post-arthroscopy to detect neurovascular compromise, such as nerve damage or impaired blood flow, which can be urgent. Wound, mobility, and skin are important but secondary.
The nurse is caring for a client who sustained a fractured tibia and fibula and has a cast applied to the extremity. Which of the following findings would indicate the client has developed compartment syndrome?
- A. The development of petechiae over the chest
- B. A new onset of dyspnea and chest pain
- C. Severe pain that is unrelieved by an opioid analgesic
- D. Localized bone pain with a fever
Correct Answer: C
Rationale: Severe, unrelieved pain is a hallmark of compartment syndrome, caused by increased pressure within a muscle compartment compromising circulation and nerve function. Petechiae and dyspnea suggest fat embolism, and bone pain with fever may indicate infection.
The nurse is teaching a client scheduled for a dual-energy x-ray absorptiometry (DEXA) scan. Which of the following information should the nurse include?
- A. Do not eat or drink 6-8 hours prior to your test.'
- B. You will feel flushing as you receive the intravenous contrast.'
- C. The scan takes several hours to complete.'
- D. Please remove all metallic objects before this exam.'
Correct Answer: D
Rationale: Removing metallic objects prevents interference with the DEXA scan, which measures bone density. Fasting and contrast are not required, and the scan typically takes 10-30 minutes.