1. 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?

a.            “I will keep my BMI under 24.”

b.            “I will switch to low-tar cigarettes.”

c.             “I will start jogging twice a week.”

d.            “I will have a family tree done.”

ANS: A

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.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care)

MSC: Integrated Process: Teaching/Learning

2. 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?

a.            “I will eat more vegetables and less meat.”

b.            “I will avoid exercising to minimize wear on my joints.”

c.             “I will take calcium with vitamin D every day.”

d.            “I will start swimming twice a week.”

ANS: D

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.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care)

MSC: Integrated Process: Teaching/Learning

3. 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?

a.            “Take this medication at bedtime because it will make you sleepy.”

b.            “Take calcium and vitamin D supplements daily.”

c.             “Eat a high-fiber diet with lots of lean meats.”

d.            “Wash your face twice a day with an antibacterial soap.”

ANS: B

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.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care)

MSC: Integrated Process: Teaching/Learning

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

a.            “I need to keep my leg positioned away from my body.”

b.            “I may have a continuous passive motion machine for a few days.”

c.             “I may need more pain medicine than I did with my hip replacement.”

d.            “I probably can get back to work within 2 to 3 weeks.”

ANS: A

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.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Potential for Complications From Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Evaluation)

5. 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?

a.            “It will help prevent bedsores from developing.”

b.            “It will help prevent nerve damage and foot drop.”

c.             “It will keep the new hip from becoming dislocated.”

d.            “It will prevent climbing out of bed if he becomes confused.”

ANS: C

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.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 325

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Potential for Complications From Surgical Procedures and Health Alterations)

MSC: Integrated Process: Communication and Documentation

6. 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?

a.            Assess circulatory status of the right leg.

b.            Notify the surgeon immediately.

c.             Measure leg circumference at the calf.

d.            Check for bilateral Homans’ signs.

ANS: A

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.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Potential for Complications From Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Assessment)

7. 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?

a.            Take the client’s blood pressure in both arms.

b.            Call the physician to clarify the orders.

c.             Schedule a preoperative electrocardiogram.

d.            Review the client’s laboratory values.

ANS: B

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.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral Therapies—Adverse Effects/Contraindications/Interactions/Side Effects)

MSC: Integrated Process: Nursing Process (Implementation)