A nurse is teaching a client who has osteoarthritis of the hip and knee about self-management of the disease. Which statements should the nurse include in the teaching? Select All That Apply.

"Apply heat to your joints to alleviate pain."

Use a firm mattress for sleeping."

"Sleep with a pillow under your knees."

"Avoid bending your joints to the point where they become painful when exercising."

"Take tub baths instead of showers."

Answer and Explanation

Correct Answer : A,B,D

Osteoarthritis (OA) is a chronic degenerative joint disorder characterized by cartilage breakdown, synovial inflammation, osteophyte formation, and progressive joint space narrowing, leading to pain, stiffness (especially after inactivity), decreased mobility, and functional impairment primarily in weight-bearing joints such as hips and knees.

Rationale:

A. This is correct because heat therapy promotes vasodilation, reduces joint stiffness, improves synovial fluid viscosity, and decreases pain perception in chronic degenerative joint disease, improving functional mobility in osteoarthritis.

B. This is correct because a firm mattress supports spinal alignment and reduces joint stress during sleep. It helps prevent abnormal joint positioning and minimizes morning stiffness commonly seen in osteoarthritic joints.

C. This is incorrect because placing a pillow under the knees promotes knee flexion contractures, reduces joint extension, and worsens long-term deformity in osteoarthritis, especially in weight-bearing joints already prone to stiffness and limited range of motion.

D. This is correct because avoiding pain-induced joint stress during exercise prevents further cartilage degeneration and inflammation. Exercise should remain within a tolerable range to maintain mobility without exacerbating joint destruction and synovial irritation.

E. This is incorrect because tub baths increase risk of falls, especially in clients with reduced mobility and joint instability. Safer alternatives include showers with assistive devices, as osteoarthritis impairs balance and lower extremity strength.

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Correct Answer is B

Explanation

A generalized vesiculopustular rash with lesions in the same stage of development is highly suggestive of a viral orthopox infection, consistent with monkeypox, which is transmitted via respiratory droplets, direct contact with lesions, and contaminated fomites. Infection control requires airborne-level precautions due to potential aerosolization during close patient contact and procedures.

Rationale:

A. No respiratory protection is inappropriate because suspected orthopox viral infections require transmission-based precautions. Close-contact spread and droplet dissemination can occur, placing staff at risk without respiratory protection.

B. An N95 particulate respirator provides airborne and droplet protection, filtering infectious particles during close patient care. This is required when managing suspected orthopox infections with rash and systemic viral presentation to prevent inhalation exposure.

C. A surgical mask with eye shield offers droplet protection only, which is insufficient for suspected orthopoxvirus cases. It does not provide adequate filtration of airborne particles during prolonged or close exposure to infected lesions.

D. A double-layered surgical mask does not meet respiratory protection standards for high-risk viral infections. It lacks certified filtration efficiency and does not protect against aerosolized particles or close-contact viral transmission risks.

A. Place the client on oxygen via nasal cannula B. Have the client turn, cough and deep breathe C. Notify the provider of the results D. Check the client’s pulse oximeter reading

Correct Answer is B

Explanation

Respiratory acidosis occurs when alveolar hypoventilation impairs the clearance of carbon dioxide, leading to hypercapnia. The kidneys eventually compensate through bicarbonate retention, but acute shifts cause rapid pH drops below 7.35. Obstruction or impaired gas exchange are the primary physiological triggers for this acid-base imbalance.

Rationale:

A. Oxygen administration treats hypoxemia, but the client’s PaO2 of 87 mmHg is currently within the normal 80-100 mmHg range. This intervention does not address the underlying hypercapnia or the elevated PaCO2 level. Oxygen won't improve ventilation mechanics in this specific scenario.

B. This is the priority intervention to facilitate carbon dioxide removal. Promoting lung expansion and clearance of secretions through coughing and deep breathing improves alveolar ventilation and restores acid-base balance. It addresses the root cause of respiratory acidosis directly.

C. While the provider should be informed of abnormal results, the nurse must first implement independent nursing interventions. Stabilizing the client through improved ventilation is the immediate priority before performing clerical notification. Immediate clinical action takes precedence over reporting.

D. The pulse oximetry provides a non-invasive estimate of oxygen saturation, but the ABG already confirms a normal PaO2 level. Obtaining more data on oxygenation is redundant and delays the necessary treatment for respiratory distress. Focus must remain on correcting the pH.

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