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Which instructions should the nurse reinforce in a teaching plan for a person with gouty arthritis?
- A. Avoid excessive alcohol.
- B. Maintain rest and immobility while disease is symptomatic.
- C. Check urine and urine output for possible kidney stones.
- D. Include food high in purine in the diet.
- E. Use bed cradle to support linens.
Correct Answer: A,B,C,E
Rationale: The person with gout should avoid alcohol and food with high purine content, maintain rest and immobility while symptomatic, and check urine and urine output for possible kidney stones. A bed cradle keeps the linens off the patient's feet to promote comfort.
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A patient has been casted to stabilize a fracture of the right radius and ulna. The nurse assesses a capillary refill of 5 seconds and cold fingers of the right hand. Which initial intervention should the nurse deploy?
- A. Notify the charge nurse of a probable compartment syndrome.
- B. Apply a warm compress to the fingers to relieve swelling.
- C. Elevate the right hand to heart level to maintain arterial pressure.
- D. Cut the cast off to release constriction.
Correct Answer: C
Rationale: The nurse should first elevate the right hand to heart level and notify the charge nurse. Permanent damage can occur in as little time as 6 hours. While the charge nurse does need to be notified it is most crucial to elevate the hand to heart level first. A warm compress would likely cause blood vessels to dilate, worsening the edema. The nurse cannot independently cut the cast off.
Which will the nurse stress to a patient who has had a knee replacement and is beginning strengthening exercises for the unaffected leg?
- A. Flex the knee and flex the foot.
- B. Lift the leg from the mattress and rotate the foot.
- C. Pull knee to chest and extend the foot.
- D. Push foot down against the footboard for a count of five.
Correct Answer: D
Rationale: The unaffected leg should be strengthened by pushing the foot down against the footboard for a count of five and repeating frequently during the day.
Which will the home health nurse include monitoring for in the plan of care for an 82-year-old female with severe kyphosis from ankylosis?
- A. Urinary output
- B. Respiratory effort
- C. Sleep cycle
- D. Nutritional status
Correct Answer: B
Rationale: Severe kyphosis may hinder the patient's ability to expand the rib cage and interfere with easy respiration. Severe kyphosis due to ankylosis will not affect the urinary output or the sleep cycle. Nutritional status is not necessarily impaired from severe kyphosis.
Which instruction will the nurse reinforce for a patient who is taking alendronate?
- A. Take drug with any meal.
- B. Take drug first thing in the morning.
- C. Drink at least $5 \mathrm{oz}$ of milk before taking drug.
- D. Take drug with an antacid to avoid heartburn.
Correct Answer: B
Rationale: Alendronate should be taken on an empty stomach first thing in the morning with $6 \mathrm{oz}$ of water, accompanied by no other medication. The patient should remain upright for 30 minutes after a dose to minimize risk of esophageal irritation.
The office nurse has noted the presence of an increase in lumbar curvature in a 20-year-old female patient. What is this condition known as?
- A. Scoliosis
- B. Lordosis
- C. Kyphosis
- D. Spondylitis
Correct Answer: B
Rationale: Common deformities include an increase in the curve at the lumbar space region that throws the shoulder back, making the 'lordly or kingly' appearance that is known as lordosis. Scoliosis involves the S curvature of the spine. Kyphosis is the rounding of the thoracic spine. Spondylitis is not explained as an increase in lumbar curvature.