A nurse in an outpatient clinic is caring for an older adult female client.
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.
The Correct Answer is []
Rationale for Correct Choices
• Osteoarthritis: The client presents with chronic, localized joint pain in the right knee and left wrist over 2 years, along with crepitus—this is highly characteristic of osteoarthritis (OA), a degenerative joint disorder. OA typically affects weight-bearing joints and is non-inflammatory in nature. Laboratory findings support this diagnosis because ANA is negative, rheumatoid factor is within normal limits, ESR is not elevated beyond normal limits, and there are no systemic symptoms such as rash or fever.
• Instruct the client to apply topical analgesics: Topical analgesics (e.g., NSAID creams) help reduce localized joint pain and inflammation in osteoarthritis without systemic side effects. This is appropriate for chronic degenerative joint pain management.
• Instruct the client to apply heat and cold: Heat helps relax muscles and improve joint mobility, while cold reduces inflammation and pain after activity. Alternating therapy is a standard non-pharmacologic intervention for osteoarthritis symptom relief.
• ESR: Erythrocyte sedimentation rate is a nonspecific marker of inflammation. Although typically normal in osteoarthritis, monitoring helps differentiate OA from inflammatory conditions if symptoms change.
• Joint deformities: Progressive joint degeneration in osteoarthritis can eventually lead to deformities, reduced mobility, and functional decline. Monitoring helps assess disease progression and effectiveness of symptom management.
Rationale for Incorrect Choices
• Gout: Although uric acid is at the upper limit of normal, gout typically presents with acute, episodic, intensely painful attacks (often in the big toe), which is not described here. This client has chronic, gradual pain without acute flares.
• Systemic lupus erythematosus (SLE): SLE would typically present with multisystem involvement, including rash (especially malar rash), photosensitivity, and positive ANA. This client has negative ANA and no systemic symptoms.
• Rheumatoid arthritis (RA): RA typically involves symmetric joint pain, morning stiffness, elevated inflammatory markers, positive rheumatoid factor, and possible joint deformities affecting multiple joints. This client has localized, non-symmetric joint involvement and normal inflammatory labs.
• Instruct the client to avoid live vaccines: This is appropriate for immunosuppressed clients (e.g., RA on immunosuppressants), which does not apply here.
• Instruct the client to use mild soaps for cleaning skin: This is more relevant to dermatologic or autoimmune skin conditions like SLE.
• Instruct the client to avoid foods high in purines: This is specifically related to gout management, not osteoarthritis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Rationale:
A. The nurse should not investigate by questioning other children. This can compromise confidentiality, lead to unreliable information, and may interfere with formal reporting procedures. The nurse’s role is to recognize and report suspected abuse, not to conduct a peer investigation.
B. Reporting suspected child abuse does not follow an administrative or school governance chain of command. The appropriate action is a direct report to the designated child protection authority, not school board officials.
C. School nurses are mandated reporters and are legally required to report any reasonable suspicion of child abuse or neglect directly to child protective services or the appropriate child welfare agency. Unexplained bruises are concerning for possible physical abuse and must be reported promptly to ensure the child’s safety and initiate an official investigation.
D. While communication with guardians may occur in some situations, it is not appropriate when abuse is suspected. Contacting caregivers first may place the child at further risk if the caregivers are involved in the abuse. The priority is immediate reporting to protective services.
Correct Answer is A
Explanation
Rationale:
A. The client with moderate Alzheimer’s disease is demonstrating confusion and likely confabulation (filling in memory gaps with incorrect but plausible ideas). The nurse should use validation, redirection, and simple structured responses. This answer avoids confrontation, reduces anxiety, and gently redirects the client to a routine activity (breakfast) before addressing the request later, which is appropriate for cognitive impairment care.
B. Asking “why” questions can increase confusion, frustration, or agitation in clients with dementia. They may not be able to explain their thinking due to impaired memory and reasoning, leading to distress rather than clarity.
C. This response is non-therapeutic and may further confuse the client. The nurse should not redirect basic reality-based confusion to the provider, especially when the issue is related to cognitive impairment rather than a medical decision requiring provider input.
D. Dexmethylphenidate is a central nervous system stimulant and is not used to manage Alzheimer’s disease symptoms. Pharmacologic management of Alzheimer’s typically includes cholinesterase inhibitors or NMDA receptor antagonists, not stimulants for situational confusion.
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