A nurse is planning care for a client who has rheumatoid arthritis and has moderate to severe pain in multiple joints. Which of the following actions should the nurse plan to take?

Perform ADLs for the client to promote rest.

Allow for frequent rest periods throughout the day.

Use heat to reduce joint inflammation.

Develop a daily schedule for acetaminophen up to 6 g/day that covers peak periods of pain.

Answer and Explanation

The Correct Answer is B

A. Perform ADLs for the client to promote rest. This is incorrect because performing ADLs for the client can increase their dependence and decrease their self-esteem. The nurse should encourage the client to perform ADLs as much as possible, with assistance as needed, to maintain their function and mobility.

B. Allow for frequent rest periods throughout the day. This is correct because rest periods can help reduce fatigue and pain, as well as prevent joint damage and inflammation. The nurse should balance rest and activity for the client and avoid overexertion.

C. Use heat to reduce joint inflammation. This is incorrect because heat can increase inflammation and pain in acute rheumatoid arthritis. The nurse should use cold applications to reduce swelling and inflammation in acute episodes, and use heat for chronic stiffness and pain.

D. Develop a daily schedule for acetaminophen up to 6 g/day that covers peak periods of pain. This is incorrect because acetaminophen has a maximum daily dose of 4 g/day, and exceeding this dose can cause liver toxicity. The nurse should monitor the client's liver function and use other analgesics as prescribed.

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Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"B"}

Explanation

A. Postpartum hemorrhage is incorrect because the client has scant lochia rubra and a firm fundus at the umbilicus, which indicate normal uterine involution and bleeding.

B. Seizures is correct because the client has signs of severe preeclampsia, such as headache, blurred vision, nausea, hyperreflexia, and clonus. These are indications of increased intracranial pressure and cerebral edema, which can lead to seizures or eclampsia.

C. Hyperglycemia is incorrect because there is no evidence of diabetes mellitus or gestational diabetes in the client's history or findings.

D. Hypoxemia is incorrect because there is no evidence of respiratory distress or impaired gas exchange in the client's history or findings.

E. Infection is incorrect because the client has no signs of infection, such as fever, malaise, foul-smelling lochia, or elevated WBC count.

A. Determine previous coping skills used by the client. B. Facilitate the client's problem-solving skillls C. Assist the client in expressing alternative behaviours. D. Establish the responsibilities of the nurse and client

Correct Answer is D

Explanation

Choice A reason:
Determine previous coping skills used by the client is not appropriate. Assessing the client's previous coping skills is an essential step in the assessment phase of the therapeutic relationship, not specifically during the orientation phase. This information helps the nurse to understand the client's coping mechanisms and identify potential areas for improvement or support.
Choice B reason:
Facilitate the client's problem-solving skills is not appropriate the nurse may work on facilitating the client's problem-solving skills throughout the therapeutic relationship, including during the working phase. During this phase, the nurse and client collaborate to explore and address the client's concerns and challenges.
Choice C reason:
Assisting the client in expressing alternative behaviours is not appropriate. This action may also be part of the working phase, where the nurse helps the client explore alternative behaviours and coping strategies to address their issues and challenges.
Choice D reason:
The orientation phase is the initial stage of the therapeutic relationship where the nurse and the client get to know each other and establish the groundwork for their working relationship. During this phase, it is essential to clarify the roles and responsibilities of both the nurse and the client to ensure a clear understanding of each other's expectations.

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A nurse is planning care for a client who has rheumatoid arthritis and has moderate to severe pain in multiple joints. Which of the following actions should the nurse plan to take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"B"}

Explanation

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Correct Answer is D

Explanation

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