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Health Care Concepts | Forsyth Tech CC
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36.A client comes to the family medicine clinic and reports joint pain and stiffness. The nurse is asked
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to assess the client for Heberden’s nodules. What assessment technique is correct?
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a Inspect the client’s distal finger joints. ss ss ss ss ss
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b Palpate the client’s abdomen for tenderness. ss ss ss ss ss
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c Palpate the client’s upper body lymph nodes. ss ss ss ss ss ss
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d Perform range of motion on the client’s wrists. ss ss ss ss ss ss ss
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ANS: A ss ss
Herberden’s nodules are seen in osteoarthritis and are bony nodules at the distal interphalangeal
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joints. To assess for this finding, the nurse inspects the client’s distal fingertips. These
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nodules are not found in the abdomen, lymph nodes, or wrists.
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37. A client takes celecoxib (Celebrex) for chronic osteoarthritis in multiple joints. After a
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knee replacement, the health care provider has prescribed morphine sulfate for
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postoperative pain relief. The client also requests the celecoxib in addition to the
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morphine. What action by the nurse is best?
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a Consult with the health care provider about administering both drugs to the client.
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b Inform the client that the celecoxib will be started when he or she goes home.
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c Teach the client that, since morphine is stronger, celecoxib is not needed.
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d Tell the client he or she should not take both drugs at the same time.
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ANS: A ss ss
Despite getting an opioid analgesic for postoperative pain, the nurse should be aware that the
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client may be on other medications for arthritis in other joints. The nonsteroidal anti-
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inflammatory drug celecoxib will also help with the postoperative pain. The nurse should
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consult the provider about continuing the celecoxib while the client is in the hospital. The
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other responses are not warranted, as the client should be restarted on this medication
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postoperatively.
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A nurse in the family clinic is teaching a client newly diagnosed with osteoarthritis (OA) about drugs
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used to treat the disease. For which medication does the nurse plan primary teaching?
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a Acetaminophen (Tylenol) ss
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b Cyclobenzaprine hydrochloride (Flexeril) ss ss
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c Hyaluronate (Hyalgan)
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d Ibuprofen (Motrin)
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ANS: ss ss A
, All of the drugs are appropriate to treat OA. However, the first-line drug is acetaminophen.
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Cyclobenzaprine is a muscle relaxant given to treat muscle spasms. Hyaluronate is a synthetic
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joint fluid implant. Ibuprofen is a nonsteroidal anti-inflammatory drug.
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A nurse is working with a community group promoting healthy aging. What recommendation is best to
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help prevent osteoarthritis (OA)?
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a Avoid contact sports. ss ss
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b Get plenty of calcium. ss ss ss
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c Lose weight if needed. ss ss ss
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d Engage in weight-bearing exercise. ss ss ss
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ANS: C ss ss
Obesity can lead to OA, and if the client is overweight, losing weight can help prevent OA or
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reduce symptoms once it occurs. Arthritis can be caused by contact sports, but this is less
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common than obesity. Calcium and weight-bearing exercise are both important for
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osteoporosis. ss
.The clinic nurse assesses a client with diabetes during a checkup. The client also has osteoarthritis
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(OA).
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The nurse notes the client’s blood glucose readings have been elevated. What question by the
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nurse is most appropriate?
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a ―Are you compliant with following the diabetic diet?‖ ss ss ss ss ss ss ss
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b ―Have you been taking glucosamine supplements?‖ ss ss ss ss ss
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c ―How much exercise do you really get each week?‖ ss ss ss ss ss ss ss ss
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d ―You’re still taking your diabetic medication, right?‖ ss ss ss ss ss ss
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ANS: B ss ss
All of the topics are appropriate for a client whose blood glucose readings have been higher
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than usual. However, since this client also has OA, and glucosamine can increase blood
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glucose levels, the nurse should ask about its use. The other questions all have an element of
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nontherapeutic communication in them. ―Compliant‖ is a word associated with negative
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images, and the client may deny being ―noncompliant.‖ Asking how much exercise the client
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―really‖ gets is accusatory. Asking if the client takes his or her medications ―right?‖ is
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patronizing. ss
The nurse working in the orthopedic clinic knows that a client with which factor has an absolute
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contraindication for having a total joint replacement?
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a Needs multiple dental fillings ss ss ss
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b Over age 85 ss ss
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c Severe osteoporosis ss
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d Urinary tract infection ss ss
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, ANS: C ss ss
Osteoporosis is a contraindication to joint replacement because the bones have a high risk of
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shattering as the new prosthesis is implanted. The client who needs fillings should have them
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done prior to the surgery. Age greater than 85 is not an absolute contraindication. A urinary tract
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infection can be treated prior to surgery.
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6. What action by the perioperative nursing staff is most important to prevent surgical wound infection
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in a client having a total joint replacement?
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a Administer preoperative antibiotic as ordered. ss ss ss ss
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b Assess the client’s white blood cell count. ss ss ss ss ss ss
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c Instruct the client to shower the night before. ss ss ss ss ss ss ss
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d Monitor the client’s temperature postoperatively. ss ss ss ss
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ANS: A ss ss
To prevent surgical wound infection, antibiotics are given preoperatively within an hour of
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surgery. Simply taking a shower will not help prevent infection unless the client is told to
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use special antimicrobial soap. The other options are processes to monitor for infection, not
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prevent it.
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A client is scheduled to have a hip replacement. Preoperatively, the client is found to be mildly
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anemic and the surgeon states the client may need a blood transfusion during or after the
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surgery. What action by the preoperative nurse is most important?
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a Administer preoperative medications as prescribed. ss ss ss ss
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b Ensure that a consent for transfusion is on the chart. ss ss ss ss ss ss ss ss ss
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c Explain to the client how anemia affects healing. ss ss ss ss ss ss ss
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d Teach the client about foods high in protein and iron. ss ss ss ss ss ss ss ss ss
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ANS: B ss ss
The preoperative nurse should ensure that all valid consents are on the chart, including one
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for blood transfusions if this may be needed. Administering preoperative medications is
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important for all preoperative clients and is not specific to this client. Teaching in the
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preoperative area should focus on immediate concerns.
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An older client is scheduled to have hip replacement in 2 months and has the following laboratory
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values: white blood cell count: 8900/mm3, red blood cell count: 3.2/mm3, hemoglobin: 9
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g/dL, hematocrit: 32%. What intervention by the nurse is most appropriate?
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a Instruct the client to avoid large crowds. ss ss ss ss ss ss
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b Prepare to administer epoetin alfa (Epogen).[ ss ss ss ss ss
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c Teach the client about foods high in iron. ss ss ss ss ss ss ss
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