Nokea
Which of the following patients seen by the nurse in the outpatient clinic is most likely to require teaching about ways to reduce risk for osteoarthritis (OA)?
- A. A 56-year-old man who is a member of a construction crew
- B. A 24-year-old man who participates in a summer softball team
- C. A 49-year-old woman who works on an automotive assembly line
- D. A 36-year-old woman who is newly diagnosed with diabetes mellitus
Correct Answer: C
Rationale: OA is more likely to occur in women as a result of estrogen reduction at menopause and in individuals whose work involves repetitive movements and lifting. Moderate exercise, such as softball, reduces risk for OA. Diabetes is not a risk factor for OA. Working on a construction crew would involve nonrepetitive work and thus would not be as risky.
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Which of the following assessment findings about a patient who has been using naproxen for 3 weeks to treat osteoarthritis is most important for the nurse to report to the health care provider?
- A. The patient has dark-coloured stools.
- B. The patient's pain has not improved.
- C. The patient is using capsaicin cream.
- D. The patient has gained 3 pounds over 3 weeks.
Correct Answer: A
Rationale: Dark-coloured stools may indicate that the patient is experiencing gastrointestinal bleeding caused by the naproxen. The information about the patient's ongoing pain and weight gain also will be reported and may indicate a need for a different treatment or counselling about avoiding weight gain, but these are not as large a concern as the possibility of gastrointestinal bleeding. Use of capsaicin cream with oral medications is appropriate.
The nurse is caring for a patient who has three school-age children and recently diagnosed with rheumatoid arthritis (RA). The patient tells the nurse that the inability to be involved in many family activities is causing stress at home. Which of the following responses by the nurse is most appropriate?
- A. You may need to see a family therapist for some help.
- B. Tell me more about the situations that are causing stress.
- C. Perhaps it would be helpful for you and your family to get involved in a support group.
- D. Your family may need some help to understand the impact of your rheumatoid arthritis.
Correct Answer: B
Rationale: The initial action by the nurse should be further assessment. The other three responses might be appropriate based on the information the nurse obtains with further assessment.
The nurse is caring for a patient with polymyositis and has joint pain, an erythematous facial rash with eyelid edema, and a weak, hoarse voice. Which of the following nursing diagnoses is priority?
- A. Acute pain related to biological injury agent (inflammation)
- B. Risk for aspiration as evidenced by barrier to elevating upper body
- C. Risk for impaired skin integrity as evidenced by excretions
- D. Risk for dry eye as evidenced by insufficient knowledge of modifiable factors (eyelid swelling)
Correct Answer: B
Rationale: The patient's vocal weakness and hoarseness indicate weakness of the pharyngeal muscles and a high risk for aspiration. The other nursing diagnoses also are appropriate but are not as high a priority as the maintenance of the patient's airway.
While working at a clinic at a summer camp, the nurse sees a camper complaining of chills and muscle aches. Upon examination, the nurse notes a circular lesion with a red border and a clear centre on the camper's right arm. Which of the following actions should the nurse take next?
- A. Palpate the abdomen.
- B. Auscultate the heart sounds.
- C. Ask the patient about recent outdoor activities.
- D. Question the patient about immunization history.
Correct Answer: C
Rationale: The patient's clinical manifestations suggest possible Lyme disease. A history of recent outdoor activities such as hikes will help confirm the diagnosis. The patient's symptoms do not suggest cardiac or abdominal problems or lack of immunization.
The home health nurse is doing a follow-up visit to a patient with recently diagnosed rheumatoid arthritis (RA). Which of the following assessments made by the nurse indicates that more patient teaching is needed?
- A. The patient requires a 2-hour midday nap.
- B. The patient has been taking 9 Aspirins daily.
- C. The patient sits on a stool when preparing meals.
- D. The patient sleeps with two pillows under the head.
Correct Answer: D
Rationale: The joints should be maintained in an extended position to avoid contractures, so patients should use a small, flat pillow for sleeping. The other information is appropriate for a patient with RA and indicates that teaching has been effective.