Question 1

The home care nurse is making a follow-up visit to a client who had total hip replacement surgery 2 weeks ago.Which client statement indicates a need for clarification regarding postoperative routine?

Accepted Answer

Crossing the legs beyond midline can dislocate the new hip joint and should be avoided at all times.The other statements demonstrate correct behavior and understanding.

Question 2

A client is admitted for a total hip replacement.Past medical history includes diabetes mellitus type 2,a heart attack 5 years ago,and allergies to sulfa drugs.The client currently takes insulin on a sliding scale and celecoxib (Celebrex).Before administering the client's medications,which action by the nurse is most appropriate?

Accepted Answer

Celebrex is a cyclooxygenase (COX)-2 inhibitor.These drugs are thought to cause serious adverse reactions such as myocardial infarction and renal problems.This client already has coronary artery disease and a past myocardial infarction,so the nurse should discuss the order with the physician before giving the medication.Reviewing laboratory results could indicate renal impairment,but taking the client's blood pressure and scheduling an electrocardiogram (ECG)would not take priority over discussion with the physician.

Question 3

The nurse is caring for a postoperative client on the medical-surgical unit following a total left hip replacement the previous day.During the assessment,the nurse notes that the client's left leg is cool,with weak pedal pulses.What is the nurse's first action?

Accepted Answer

The symptoms may represent impaired circulation or may be normal for this client.Before the surgeon is notified,the status of the nonoperative leg should be assessed and assessment findings on both legs compared with the client's baseline.Homans' sign (pain in the calf on dorsiflexion of the foot)is not always indicative of a deep vein thrombosis and should not be evaluated until other assessments are made.Measuring calf circumference would provide additional data related to deep vein thrombosis.

Question 4

The school nurse is working with a group of high school students who will be going on a field trip to a nature center.Which student is at highest risk for a tick bite?

Accepted Answer

Long pants should be worn and tucked into socks or boots to help prevent tick bites.Facial hair,hats,ponytails,and scented body products do not increase the risk for tick bites.

Question 5

An older adult client is scheduled for knee replacement surgery.Which statement by the client indicates a need for further preoperative instruction?

Accepted Answer

Dislocation is not a problem with knee replacement surgery,so the client does not need to keep his or her leg abducted.The other statements indicate accurate understanding of the instructions.

Question 6

The nurse is teaching a community health class about health promotion techniques.Which statement by a student indicates a strategy to help prevent the development of osteoarthritis?

Accepted Answer

Obesity increases the stress on weight-bearing joints and contributes to the development of degenerative joint disease.Smoking does not decrease risk for osteoarthritis.Jogging increases the risk because of increased wear and tear on the joints.There is a genetic link to osteoarthritis; creating a family tree might help the client discover if there is any familial link but will not help prevent the disorder.

Question 7

The nurse is teaching a client how to reduce the pain that she often experiences with fibromyalgia.Which statement does the nurse include in the teaching?

Accepted Answer

In many clients,the pain of fibromyalgia occurs as a direct response to sleep deprivation.Encouraging the client to get sufficient sleep every night can drastically reduce the amount of pain experienced.Wearing gloves will not decrease the pain of fibromyalgia,but it may help a disease such as Raynaud's phenomenon.Weight-bearing activities should not increase pain in a client with fibromyalgia.Similarly,sun exposure has not been identified as a causative pain factor.

Question 8

A client with a history of rheumatoid arthritis will be starting drug therapy with etanercept (Enbrel).What is most important for the nurse to teach the client?

Accepted Answer

Enbrel is a parenteral medication that is given by subcutaneous injection.The client and/or the family will need to be taught how to give a subcutaneous injection correctly.Blood glucose levels should not be affected by this medication.The medication is not administered IV.Drug dosages are not changed and recalculated by the client.

Question 9

The nurse provides discharge teaching for a client to prevent a new attack of gout.Which statement by the client indicates that additional teaching is required?

Accepted Answer

Nutritional therapy for gout is controversial; however,clients do need to increase their fluid intake to prevent kidney stones.Certain foods may precipitate an acute attack,so clients should learn to determine which foods trigger their gout.Aspirin is well known to trigger gout attacks.Increasing the intake of alkaline ash foods such as citrus juices and milk might prevent the formation of kidney stones.

Question 10

A client is suspected to have rheumatoid arthritis.Which manifestations does the nurse assess this client carefully for?

Accepted Answer

Low-grade fever is common with rheumatoid arthritis because of the inflammatory response.Fatigue,anorexia,and weight loss are also common symptoms.Impaired neurologic status,popping sounds with range of motion (ROM),and poor circulation are not common symptoms of rheumatoid arthritis.

Question 11

The nurse is teaching a client who has osteoarthritis ways to slow progression of the disease.Which statement indicates that the client understands the nurse's instruction?

Accepted Answer

Swimming is an excellent form of exercise for clients with arthritis because it involves minimal weight bearing and stress on the joints from gravity.Eating more vegetables will not decrease the progression of osteoarthritis.Taking calcium with vitamin D will decrease the risk of osteoporosis,not osteoarthritis.Gentle exercise is important to help slow progression of the disease.

Question 12

A client had a total knee replacement earlier in the day and has a continuous femoral nerve blockade (CFNB).When entering the room to assess the client,the nurse notes that the television volume is quite loud.The client explains that it is hard to hear with "all the ringing in my ears." What action by the nurse takes priority?

Accepted Answer

CFNB can enter the systemic circulation,causing tinnitus,nervousness,slurred speech,bradycardia,hypotension,bradypnea,and seizures.Because the client is exhibiting signs the CFNB has entered his or her circulation,the client is at risk for seizures and critical alterations in vital signs.The nurse should stay with the client and should continue to assess him or her while another nurse notifies the surgeon or the anesthesiologist.

Question 13

The nurse is caring for a client who has had hip replacement surgery 2 days before.The client reports severe pain at the surgical site despite having received 2 Vicodin (acetaminophen and hydrocodone)tablets 2 hours previously.The client is requesting IV pain medication.What is the nurse's primary intervention?

Accepted Answer

Most clients do not need IV pain medication after the first day.If the client seems to be having unusual pain,the nurse should first assess the client for other problems,such as a joint infection.If findings are normal,applying ice to the hip will help to reduce swelling and pain.It is not time for another dose of Vicodin,because it has only been 2 hours.The nurse would not contact the surgeon unless all pain methods tried did not work.The Vicodin should have worked within 2 hours,so the nurse should not tell the client that the Vicodin will work shortly.

Question 14

A client who has had bilateral total knee replacements is prescribed enoxaparin sodium (Lovenox)injections twice daily for the next 3 weeks.The client asks the nurse why she has to have the medication.What is the nurse's best response?

Accepted Answer

Lovenox is an anticoagulant that will help prevent formation of postoperative deep vein thrombosis (DVT).Lovenox does not decrease or prevent swelling,it does not prevent arthritis,and it is not an antibiotic.

Question 15

The nurse is caring for a client who had right total knee replacement surgery 3 days ago.During the assessment,the nurse notes that the client's right lower leg is twice the size of the left.What is the nurse's priority intervention?

Accepted Answer

A common complication after total knee replacement (TKR)is the formation of a thrombus below the surgical site.This complication can lead to a pulmonary embolus and can be life threatening.Before notifying the surgeon or the emergency team,assess the client's pulmonary status to determine whether he or she has any manifestations of an embolus.The client's leg may be elevated and pedal pulses palpated,but respiratory assessment must be done first.TED hose should not be applied to a leg with suspected deep vein thrombosis (DVT).

Question 16

The nurse is caring for a client who is 1 day post total hip replacement.The nurse is instructing the client about how to perform quadriceps-setting exercises correctly.Which direction does the nurse provide to the client?

Accepted Answer

Quadriceps-setting exercises are done by straightening the leg as much as possible by attempting to push the back of the knees into the mattress.The other exercises may be performed by the client as tolerated,but these items do not describe quadriceps-setting exercises.

Question 17

The nurse is working with a client who will be taking 20 mg of prednisone daily for rheumatoid arthritis.Which precautions does the nurse give the client about taking this medication?

Accepted Answer

Long-term steroid use is associated with many complications,including diabetes,infection,and osteoporosis,among others.The client should be instructed to take calcium and vitamin D supplements to help prevent osteoporosis.Prednisone does not cause constipation,so increased fiber would not be helpful.Prednisone should be taken in the morning because it may interfere with sleep if taken at bedtime.Washing the face with antibacterial soap may cause skin dryness and breakdown.

Question 18

A client is receiving warfarin (Coumadin)daily following total hip replacement surgery.Which laboratory value requires intervention by the nurse?

Accepted Answer

Blood levels of Coumadin will be monitored by checking daily PT and INR (in some places,only INR).The INR is critically high.The K⁺ is normal and is not monitored for Coumadin therapy.The PT is used in some facilities to monitor Coumadin therapy.Hemoglobin would be important to assess because a side effect of Coumadin is bleeding,and a dropping hemoglobin level would indicate that bleeding was occurring.PT and hemoglobin are within the normal range.

Question 19

A client returns to the medical-surgical unit after a total hip replacement with a large wedge-shaped pillow between his legs.The client's daughter asks the nurse why the pillow is in place.What is the nurse's best response?

Accepted Answer

Adduction of the operative leg beyond the midline could dislocate the new hip.The wedge pillow will help prevent this from happening.The wedge will not prevent bedsores from developing because it does not prevent pressure.The pillow will not prevent foot drop,because it is placed between the legs.The pillow is not a restraining device,and it will not prevent the client from climbing out of bed.

Question 20

A client who has had total hip replacement surgery asks the nurse when she will be able to use a regular-height toilet seat again.What is the nurse's best response?

Accepted Answer

When the client is able to walk without a limp,the artificial joint is seated sturdily enough in place that it will not be dislocated or dislodged by overflexing it.At that time,the client will no longer need assistive devices or ambulatory aids.With staples removed,holding the leg off the bed and taking Coumadin do not affect readiness to bend the hip enough to use a regular toilet seat.

Quiz 20: Care of Patients With Arthritis and Other Connective Tissue Diseases