Nokea
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.
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The nurse on an inpatient rheumatology unit receives a hand-off report on a client with an acute exacerbation of systemic lupus erythematosus (SLE). Which reported laboratory value requires the nurse to assess the client further?
- A. Creatinine: 3.9 mg/dL
- B. Red blood cell count: 5.2 million/µL
- C. White blood cell count: 4000/µL
- D. Platelet count: 200,000/µL
Correct Answer: A
Rationale: Lupus nephritis is the leading cause of death in clients with SLE. The creatinine level is very high and the nurse needs to perform further assessments related to this finding. The other laboratory values are normal.
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 using a continuous passive motion (CPM) machine after joint replacement. Where does the nurse place the CPM machine to prevent infection and promote safety?
- A. On the floor beside the bed
- B. On a stable surface above the floor
- C. Directly on the client's bed
- D. In a sterile equipment room
Correct Answer: B
Rationale: For infection control and to avoid tripping, the CPM machine is never placed on the floor. Placing it on a stable surface above the floor ensures safety and accessibility.
A nurse works with several clients who have gout. Which types of gout and their drug treatments are correctly matched? (Select all that apply.)
- A. Allopurinol (Zyloprim): Acute gout
- B. Colchicine (Colcrys): Acute gout
- C. Febuxostat (Uloric): Chronic gout
- D. Probenecid: Chronic gout
- E. Indomethacin: Acute gout
Correct Answer: B,C,D,E
Rationale: Colchicine and indomethacin are used for acute gout attacks. Febuxostat and probenecid are used for chronic gout management. Allopurinol is also used for chronic gout, not acute gout.
A client with rheumatoid arthritis (RA) is having difficulty completing activities of daily living (ADLs). What devices can the nurse suggest to increase the client's independence? (Select all that apply.)
- A. Grab bars
- B. Long-handled bath brushes
- C. Rocker-recliner
- D. Toothbrushes with built-up handles
- E. Wheelchair cushion
Correct Answer: A,B,D
Rationale: Grab bars, long-handled bath brushes, and toothbrushes with built-up handles all provide modifications for daily activities, making it easier for the client with RA to complete ADLs independently. The rocker-recliner and wheelchair cushion are comfort measures but do not help increase independence.