2nd Exam. med. surge 121 sep’2025

Which complication is most likely after a hip replacement surgery if the nurse allows the client to bend the hip more than 90 degrees?

A. Deep vein thrombosis

B. Dislocation of the prosthesis

C. Pressure ulcer

D. Phantom pain

Answer: B. Dislocation of the prosthesis

Clopidogrel Nursing Actions (SATA)

Which are appropriate nursing actions for a patient on clopidogrel?

A. Monitor for bleeding

B. Check platelet count periodically

C. Encourage OTC NSAID use

D. Educate about reporting dizziness or unusual bleeding

E. Teach patient to avoid abrupt cessation

Answer: A, B, D

Rationale: Clopidogrel increases bleeding risk; monitoring platelets and patient education are essential. NSAIDs increase bleeding; abrupt cessation is less critical but should be monitored.

Post amputation intervention: Which suggestions for the plan of care should a nurse make for the client with knee amputation?

Administer gabapentin for phantom limb pain.

Record amount, color, and odor of wound drainage.

Compare pulses in the affected extremity with pulses in the other extremity.

Discontinue elevation of the extremity after 24 hrs

Rheumatoid Arthritis causes

Smoking

Genetic

Hormones

Anemia Symptoms (SATA)

A client with anemia may present with which of the following?

A. Weakness

B. Tachycardia

C. Hypertension

D. Dyspnea

E. Cool, pale skin

Answer: A, B, D, E

Rationale: Anemia causes reduced oxygen-carrying capacity, leading to weakness, tachycardia, dyspnea, and pallor with cool skin. Hypertension is not a typical finding.

Allergy Assessment (SATA)

A client reports seasonal allergies. Which symptoms should the nurse expect to assess?

A. Wheezing

B. Diarrhea

C. Sneezing

D. Watery eyes

E. Jaundice

Answer: A, C, D

Rationale: Allergies commonly cause respiratory and ocular symptoms such as wheezing, sneezing, and watery eyes. Diarrhea may occur with food allergens but not typically seasonal. Jaundice is unrelated to allergies.

Bleeding Precautions (SATA)

Which actions should a nurse take for a client on bleeding precautions?

A. Use an electric razor

B. Apply firm pressure to puncture sites

C. Avoid injections if possible

D. Encourage vigorous tooth brushing

E. Monitor for hematuria and hematemesis

Answer: A, B, C, E

Rationale: Electric razors reduce the risk of cuts. Firm pressure controls bleeding. Avoiding injections reduces risk. Vigorous brushing can cause bleeding; instead, use a soft toothbrush.

Multiple Myeloma Labs (MC)

Which lab finding is consistent with multiple myeloma?

A. Decreased serum calcium

B. Increased atypical plasma cells on bone marrow aspiration

C. Low creatinine

D. Hyperkalemia

Answer: B

Rationale: Multiple myeloma is a plasma cell malignancy; bone marrow aspiration shows atypical plasma cells. Calcium is usually elevated, creatinine may rise (renal insufficiency), and potassium is not specific

Multiple myeloma Lab

CRAB –

calcium levels elevated,

renal insufficiency,

anemia,

bone lesions

Rheumatoid arthritis Assessment Findings

Sudden start (acute onset) • affect joint Symmetrically • Swollen, warm joints • Nodules - small lumps under the skin • Muscle atrophy - muscles shrink • Flexion contractures - joints bend get stuck, twisted or bent fingers

Rheumatoid Arthritis affect

Affect the organs: eyes, skin, heart, lungs, kidneys, and blood vessels.

Osteomyelitis intervention

Bone biopsy for lab test. Immobilize bone to prevent injury • Antibiotics (IV like Gentamicin) take 6weeks -2 months. After that take oral antibiotics for another weeks.

Osteomyelitis surgical intervention

debridement to remove dead tissue/ bone • Closed saline irrigation (cleaning wound with sterile fluid) • Bone or muscle flap grafts (to fill holes left by infection) impregnated bead application. • Remove any metal plates/screws if they're infected •

Amputation = last resort if infection can't be controlled

Osteoarthritis education

Lose weight, use heat or cold compression, relaxation, take ibuprofen, Low impact exercise e.g walking, biking, yoga, swimming, active ROM, light weight lift.