A nurse in an outpatient clinic is caring for a client.

Exhibits

Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

Answer and Explanation

The Correct Answer is []

Condition: Osteoarthritis

The client reports pain in the right knee and left wrist over the last two years. OA typically presents with chronic, localized joint pain, particularly in weight-bearing joints (e.g., knees) and joints that experience repetitive use (e.g., wrists).
Crepitus (a crackling or grating sound when the joint moves) is noted in both the right knee and left wrist, which is a characteristic finding in osteoarthritis due to cartilage breakdown and joint space narrowing.
The absence of systemic symptoms such as rashes or other joint pain, as well as normal laboratory values (e.g., normal ESR, normal ANA), further supports a diagnosis of osteoarthritis rather than conditions like systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA), which are associated with systemic inflammation.

Actions to Take for Osteoarthritis:

Instruct the client to apply heat and cold:

Heat and cold therapy can help manage the pain and stiffness associated with osteoarthritis. Cold therapy can reduce inflammation, while heat therapy can improve blood flow and relax the muscles around the joint.

Instruct the client to apply topical analgesics:

Topical analgesics (such as menthol or capsaicin creams) can provide localized pain relief for osteoarthritis. They are commonly used as part of the non-pharmacological treatment approach for joint pain.

Parameters to Monitor for Osteoarthritis:

ESR (Erythrocyte Sedimentation Rate):

While osteoarthritis is generally not associated with systemic inflammation, monitoring the ESR can help ensure that there are no signs of additional inflammatory processes (such as rheumatoid arthritis) that might be missed. In this case, the client's ESR is within the normal range (20 mm/hr), which supports the diagnosis of osteoarthritis.

Joint deformities:

Monitoring for joint deformities over time is essential in osteoarthritis to assess disease progression. OA can lead to the formation of osteophytes (bone spurs) and other joint deformities that might impair function.

Explanation for incorrect choices; Systemic Lupus Erythematosus (SLE):

SLE typically presents with a variety of symptoms, including a characteristic butterfly-shaped rash on the face, photosensitivity, and systemic involvement such as kidney or neurological issues. The client does not exhibit any skin rashes, systemic symptoms, or abnormal ANA (antinuclear antibody), which would be elevated in SLE.

Gout:

Gout involves the deposition of uric acid crystals in joints, leading to sudden, severe pain, usually in the big toe (but other joints can be involved). While the client has a mildly elevated uric acid level (7.2 mg/dL, which is within the upper limit), there are no signs of an acute gout flare (such as intense joint pain, redness, and swelling). Additionally, the client’s symptoms are chronic, which is more consistent with OA.

Rheumatoid Arthritis (RA):

RA is an autoimmune disease that causes inflammation and deformities in the joints, usually in a symmetrical pattern (e.g., both wrists or knees). The client’s presentation does not fit this pattern, and laboratory results (normal ANA, ESR) do not suggest an autoimmune inflammatory condition like RA.

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Correct Answer is B

Explanation

A. Restraints should never be attached to the side rails, as this can increase the risk of injury.
B. The client's condition should be documented every 15 minutes to ensure their safety and comfort while in restraints.
C. A PRN prescription for restraints is not appropriate; restraints should be used only as a last resort and with a physician's order.
D. The restraint should be removed at least every 2 hours to assess for skin integrity and allow for range- of-motion exercises.

A. A client who has sinus arrhythmia and is receiving cardiac monitoring. B. A client who has epidural analgesia and weakness in the lower extremities. C. A client who has a hip fracture and a new onset of tachypnea. D. A client who has diabetes mellitus and an HbA1c of 7.2% (less than 7%).

Correct Answer is C

Explanation

A. Sinus arrhythmia is typically not life-threatening and does not require immediate assessment unless other symptoms are present.
B. Epidural analgesia can cause some weakness in the lower extremities, but this is a known side effect and not an emergency.
C. Tachypnea, especially with a new onset in a client with a hip fracture, may indicate complications such as a fat embolism or pulmonary embolism, which require immediate assessment.
D. An HbA1c of 7.2% is slightly above the target but is not an immediate concern compared to other acute symptoms.

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Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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Correct Answer is C

Explanation

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