Chapter 43: Concepts of Care for Patients With Arthritis and Total Joint Arthroplasty

The nurse is caring for a client who has severe osteoarthritis. What primary joint problems

will the nurse expect the client to report?

a. Crepitus

b. Effusions

c. Pain

d. Deformities

c pain

A nurse is teaching a client newly diagnosed with osteoarthritis (OA) about drugs used to treat the disease. For which drug does the nurse plan health teaching?

a. Acetaminophen

b. Cyclobenzaprine hydrochloride

c. Hyaluronate

d. Ibuprofen

a. Acetaminophen

The nurse assesses a client with diabetes and osteoarthritis (OA) during a checkup. The nurse

notes the client's blood glucose readings have been elevated. What question by the nurse is

most appropriate?

a. "Are you following the prescribed diabetic diet?"

b. "Have you been taking glucosamine supplements?"

c. "How much exercise do you really get each week?"

d. "You're still taking your diabetic medication, right?"

b. "Have you been taking glucosamine supplements?"

The nurse interviews an older client with moderate osteoarthritis and her husband. What psychosocial assessment question would the nurse include?

a. "Do you feel like hurting yourself or others?"

b. "Are you planning to retire due to your disease?"

c. "Do you ask your husband for assistance?"

d. "Do you experience discomfort during sex?"

d. "Do you experience discomfort during sex?"

The nurse assesses a client after a total hip arthroplasty. The client's surgical leg is visibly

shorter than the other one and the client reports extreme pain. While a co-worker calls the

surgeon, what action by the nurse is appropriate?

a. Assess neurovascular status in both legs.

b. Elevate the surgical leg and apply ice.

c. Prepare to administer pain medication.

d. Try to place the surgical leg in abduction.

a. Assess neurovascular status in both legs.

The nurse is teaching a client who is prescribed acetaminophen for control of osteoarthritic joint pain. What statement by the client indicates a need for further teaching?

a. "I won't take more than 5000 mg of this drug each day."

b. "I'll follow up to get my lab tests done to check my liver."

c. "I'll check drugs that I take for acetaminophen in them."

d. "I can use topical patches and creams to help relieve pain."

a. "I won't take more than 5000 mg of this drug each day."

After a total knee arthroplasty, a client is on the postoperative nursing unit with a continuous

femoral nerve blockade. On assessment, the nurse notes the skin of both legs is pale pink,

warm, and dry, but the client is unable to dorsiflex or plantarflex the surgical foot. What

action would the nurse take next?

a. Document the findings and monitor as prescribed.

b. Increase the frequency of monitoring the client.

c. Notify the surgeon or anesthesia provider immediately.

d. Palpate the client's bladder or perform a bladder scan.

c. Notify the surgeon or anesthesia provider immediately.

A client is prescribed celecoxib for joint pain. What statement by the client indicates a need

for further teaching?

a. "I'll report any signs of bleeding or bruising to my primary health care provider."

b. "I'll take this drug only as prescribed by my primary health care provider."

c. "I'll be sure to take this drug three times a day only on an empty stomach."

d. "I'll monitor the amount of urine that I excrete every day and report any changes."

c. "I'll be sure to take this drug three times a day only on an empty stomach."

The nurse is teaching a client who is planning to have a total hip arthroplasty. What statement

by the client indicates a need for further teaching?

a. "I will get an IV antibiotic right before surgery to prevent infection."

b. "I may request a regional nerve block as part of the surgical anesthesia."

c. "I will receive IV heparin before surgery to decrease the risk of clots."

d. "I will receive tranexamic acid to help reduce blood loss during surgery."

c. "I will receive IV heparin before surgery to decrease the risk of clots."

A client asks the nurse about having a total knee arthroplasty to relieve joint pain. Which

factor would place the client at the highest risk for impaired postoperative healing?

a. Controlled hypertension

b. Obesity

c. Osteoarthritis

d. Mild osteopenia

b. Obesity

A nurse assesses a group of clients who have rheumatoid arthritis (RA). Which client would

the nurse see first?

a. Client who reports jaw pain when eating

b. Client with a red, hot, swollen right wrist

c. Client who has a puffy-looking area behind the knee

d. Client with a worse joint deformity since the last visit

b. Client with a red, hot, swollen right wri

The nurse assesses a client with rheumatoid arthritis (RA) and Sjögren syndrome. What

assessment would be most important for this client?

a. Abdominal assessment

b. Oxygen saturation

c. Breath sounds

d. Visual acuity

d. Visual acuity

A client who has rheumatoid arthritis is prescribed etanercept. What health teaching by the nurse about this drug is appropriate?

a. Giving subcutaneous injections

b. Having a chest x-ray once a year

c. Taking the medication with food

d. Using heat on the injection site

a. Giving subcutaneous injection

A client with rheumatoid arthritis (RA) has an acutely swollen, red, and painful joint. What

nonpharmacologic intervention does the nurse recommend?

a. Heating pad

b. Ice packs

c. Splint

d. Paraffin dip

b. Ice packs

A client is scheduled to have a total hip arthroplasty. What preoperative teaching by the nurse is most important?

a. Teach the need to discontinue all medications for 5 days before surgery.

b. Teach the patient about foods high in protein, Vitamin C, and iron.

c. Explain to the client the possible need for blood transfusions postoperatively.

d. Remind the client to have all dental procedures completed at least 2 weeks prior to surgery.

d. Remind the client to have all dental procedures completed at least 2 weeks prior to surgery.

A client is getting out of bed into the chair for the first time after an uncemented total hip

arthroplasty. What action by the nurse is appropriate?

a. Have adequate help to transfer the patient.

b. Provide socks so the patient can slide easier.

c. Tell the patient full weight bearing is allowed.

d. Use a footstool to elevate the patient's leg.

a. Have adequate help to transfer the patient.

A client has long-term rheumatoid arthritis that especially affects the hands. The client wants to finish quilting a baby blanket before the birth of her grandchild. What response by the nurse is appropriate?

a. "Let's ask your provider about increasing your pain pills."

b. "Hold ice bags against your hands before quilting."

c. "Try a paraffin wax dip 20 minutes before you quilt."

d. "You need to stop quilting before it destroys your fingers."

c. "Try a paraffin wax dip 20 minutes before you quilt."

A client has a left knee arthrocentesis to remove excess joint fluid. What postprocedure health teaching will the nurse include?

a. "Take your opioid medication as prescribed by the primary health care provider."

b. "Do not bear weight on your left leg for at least a week after you get home."

c. "Monitor the site for bleeding or clear fluid leakage when you are home."

d. "Tell your employer that you can't come back to work for 2 to 3 weeks."

c. "Monitor the site for bleeding or clear fluid leakage when you are home."

The primary health care provider prescribes methotrexate (MTX) for a client with a new diagnosis of rheumatoid arthritis. The nurse provides health teaching about the drug. What statement by the nurse is appropriate to include about methotrexate?

a. "It will take at least 1 to 2 weeks for the drug to help relieve your symptoms."

b. "The drug is very expensive but there are pharmacy plans to help pay for it."

c. "The drug can increase your risk for infection, so you should avoid crowds."

d. "It's OK for you to drink about 2 to 3 glasses of wine each week while taking the

drug."

c. "The drug can increase your risk for infection, so you should avoid crowds."

The nurse is assessing a client with long-term rheumatoid arthritis (RA) who has been taking prednisone for 10 years. For which complications of chronic drug therapy would the nurse assess? (Select all that apply.)

a. Osteoporosis

b. Diabetes mellitus

c. Glaucoma

d. Hypertension

e. Hypokalemia

f. Decreased immunity

a. Osteoporosis

b. Diabetes mellitus

c. Glaucoma

d. Hypertension

e. Hypokalemia

f. Decreased immunity

The nurse is teaching a client with mild rheumatoid arthritis (RA) about how to protect

synovial joints. Which health teaching will the nurse include? (Select all that apply.)

a. "Use small joints rather than larger ones during tasks."

b. "Use both hands instead of one with holding objects."

c. "When getting out of bed or a chair, use the palms of your hands."

d. "Bend your knees instead of your waist and keep your back straight."

e. "Do not use multiple pillows under your head to prevent neck flexion."

f. "Use a device or rubber grip to open jars or bottle tops."

g. "Use long-handled devices such as a hairbrush with an extended handle."

b. "Use both hands instead of one with holding objects."

c. "When getting out of bed or a chair, use the palms of your hands."

d. "Bend your knees instead of your waist and keep your back straight."

e. "Do not use multiple pillows under your head to prevent neck flexion."

f. "Use a device or rubber grip to open jars or bottle tops."

g. "Use long-handled devices such as a hairbrush with an extended handle."

A client who had a recent total knee arthroplasty will be using a continuous passive motion

(CPM) machine after discharge at home. What health teaching about the CPM machine will

the nurse include? (Select all that apply.)

a. "Keep the machine padded well to prevent skin breakdown."

b. "Ensure that your leg is placed properly on the machine."

c. "Use the machine as prescribed but not at mealtime."

d. "When the machine is not being used, do not store it on the floor."

e. "Check that the cycle and range of motion is kept at the level prescribed."

a. "Keep the machine padded well to prevent skin breakdown."

b. "Ensure that your leg is placed properly on the machine."

c. "Use the machine as prescribed but not at mealtime."

d. "When the machine is not being used, do not store it on the floor."

e. "Check that the cycle and range of motion is kept at the level prescribed."

The nurse assesses a client with long-term rheumatoid arthritis (RA) for late signs and symptoms. Which assessment findings will the nurse document as late signs and symptoms of

RA? (Select all that apply.)

a. Anorexia

b. Felty syndrome

c. Joint deformity

d. Low-grade fever

e. Weight loss

b. Felty syndrome

c. Joint deformity

e. Weight loss

The nurse is teaching assistive personnel about postoperative care for an older adult who had a posterolateral total hip arthroplasty. What teaching will the nurse include? (Select all that apply.)

a. "Move the client slowly to prevent dizziness and a possible fall."

b. "Encourage the client to deep breathe and cough at least every 2 hours."

c. "Help the client use the incentive spirometer at least every 2 hours."

d. "Keep the abduction pillow in place at all times while the client is in bed."

e. "Let me know if the client has an elevated temperature or pulse."

f. "Keep in mind that the client may be a little confused after surgery."

g. "Please let me know if you see any reddened or open skin areas during bathing."

a. "Move the client slowly to prevent dizziness and a possible fall."

b. "Encourage the client to deep breathe and cough at least every 2 hours."

c. "Help the client use the incentive spirometer at least every 2 hours."

d. "Keep the abduction pillow in place at all times while the client is in bed."

e. "Let me know if the client has an elevated temperature or pulse."

f. "Keep in mind that the client may be a little confused after surgery."

The nurse is caring for an older client who had a total knee arthroplasty. Prior to surgery, the

client lived alone independently. With which interprofessional health care team members will

the nurse collaborate to ensure positive client outcomes? (Select all that apply.)

a. Case manager

b. Mental health counselor

c. Physical therapist

d. Occupational therapist

e. Speech-language pathologist

f. Clergy/Spiritual leader

a. Case manager

c. Physical therapist

A client asks the nurse about what medications may be included for nonopioid multimodal analgesia following a total knee arthroplasty. What medications may be given to the client?

(Select all that apply.)

a. Gabapentin

b. Ketorolac

c. Hydrocodone

d. Ketamine

e. Morphine

f. Bupivacaine

a. Gabapentin

b. Ketorolac

d. Ketamine

f. Bupivacaine

A client has rheumatoid arthritis (RA) and the nurse is conducting a home assessment. What

options can the nurse suggest for the client to maintain independence in activities of daily living (ADLs)? (Select all that apply.)

a. Grab bars to reach high items

b. Long-handled bath scrub brush

c. Soft rocker-recliner chair

d. Toothbrush with built-up handle

e. Wheelchair cushion for comfort

a. Grab bars to reach high items

b. Long-handled bath scrub brush

d. Toothbrush with built-up handle

A nurse is visiting a client discharged home after a total hip arthroplasty. What safety

precautions would the nurse recommend to the client and family? (Select all that apply.)

a. Buy and install an elevated toilet seat.

b. Install grab bars in the shower and by the toilet.

c. Step into the bathtub with the affected leg first.

d. Remove all throw rugs throughout the house.

e. Use a shower chair while taking a shower.

a. Buy and install an elevated toilet seat.

b. Install grab bars in the shower and by the toilet.

d. Remove all throw rugs throughout the house.

e. Use a shower chair while taking a shower.

A nurse is planning postoperative care for a client following a total hip arthroplasty. What nursing interventions would help prevent venous thromboembolism for this client? (Select all

that apply.)

a. Early ambulation

b. Fluid restriction

c. Quadriceps-setting exercises

d. Compression stockings/devices

e. Anticoagulant drug therapy

a. Early ambulation

c. Quadriceps-setting exercises

d. Compression stockings/devices

e. Anticoagulant drug therapy