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 ["A","B","F"]

Explanation

Rationale
A. Review the need for the indwelling urinary catheter daily.
One of the most effective strategies to prevent UTIs is avoiding unnecessary catheterization. The nurse should regularly assess whether the catheter is still necessary and remove it as soon as possible. Keeping a catheter in place longer than needed increases the risk of infection.
B. Encourage the client to drink 3000 mL of fluid daily.
Increasing fluid intake is generally a good measure to help flush the urinary tract, reducing the concentration of bacteria and preventing infections. However, for clients with heart failure, excessive fluid intake can exacerbate fluid overload, leading to pulmonary edema and worsened symptoms of heart failure. Therefore, the nurse should consult the healthcare provider before recommending a specific amount of fluid intake (such as 3000 mL). The nurse should ensure that the client’s fluid intake is balanced with their heart failure management plan.
C. Place the drainage bag on the bed when transporting the client.
The drainage bag should always be kept below the level of the bladder to prevent urine from flowing back into the bladder, which can lead to infections. Placing the drainage bag on the bed when transporting the client would increase the risk of urine reflux, potentially leading to a UTI. The bag should be secured properly and kept off the bed or floor during transport.
D. Empty the drainage bag when it is half-full.
The drainage bag should be emptied when it is full (typically around 2/3 to 3/4 full) to prevent overfilling, which can increase the risk of backflow or spillage. Emptying the bag when it is half-full may lead to unnecessary handling of the catheter and increases the risk of contamination. It’s important to empty the bag regularly, but not excessively often.
E. Change the indwelling urinary catheter tubing every 3 days.
There is no need to change the indwelling catheter tubing on a regular basis unless there is a specific indication (e.g., blockage or infection). Frequent changes of the catheter tubing increase the risk of introducing bacteria. According to best practice guidelines, the catheter should be changed only when necessary, not routinely every 3 days.
F. Use soap and water to provide perineal care.
Regular and gentle perineal care with soap and water is crucial for reducing the risk of UTIs. The perineal area should be cleaned daily and after any incontinence episodes to minimize bacterial contamination of the catheter and urinary tract. It’s important to avoid harsh chemicals, which could irritate the skin and urinary tract.

A. "I can go jogging after 2 weeks." B. "I can resume activities, such as sewing," C. "I should bend at the waist when putting on my shoes." D. "I can lift objects that are less than 10 pounds."

Correct Answer is D

Explanation

A. The client should avoid high-impact activities like jogging until cleared by the provider.
B. Resuming activities like sewing too soon can strain the eyes, especially after retinal surgery.
C. Bending at the waist should be avoided after retinal surgery, as it may increase intraocular pressure.
D. Lifting objects less than 10 pounds is generally safe after retinal surgery, but heavier lifting should be avoided until cleared by the provider.

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a client in the medical-surgical unit. Exhibits Which of the following actions should the nurse take to decrease the risks for urinary tract infection for this client? Select all that apply.

Correct Answer is ["A","B","F"]

Explanation

A nurse is providing discharge teaching to a client who is postoperative following the surgical repair of a detached retina. Which of the following statements by the client indicates an understanding of the teaching?

Correct Answer is D

Explanation

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