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
The Correct Answer is B
Allow for frequent rest periods throughout the day.
- 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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Preeclampsia is not a contraindication for the administration of misoprostol for induction of labor. Misoprostol is a prostaglandin E1 analog used for cervical ripening and induction of labor. It is not contraindicated in patients with preeclampsia. However, its use should be carefully monitored in patients with hypertensive disorders of pregnancy due to the potential impact on blood pressure.
Choice B rationale:
Transverse fetal lie is a contraindication for the administration of misoprostol for induction of labor. Misoprostol should not be used when the baby is in a transverse position because it can lead to complications during delivery. Induction methods should be chosen carefully based on the fetal presentation to ensure a safe delivery process.
Choice C rationale:
Intrauterine growth restriction (IUGR) is not a contraindication for the administration of misoprostol for induction of labor. IUGR refers to a condition where a fetus does not grow at the expected rate inside the uterus. While the cause of IUGR needs to be addressed, misoprostol itself is not contraindicated in these cases. However, the healthcare provider should assess the overall fetal well-being before deciding on the induction method.
Choice D rationale:
Postterm pregnancy is not a contraindication for the administration of misoprostol for induction of labor. In postterm pregnancies, where the pregnancy has extended beyond 42 weeks, healthcare providers may consider inducing labor to prevent complications associated with prolonged gestation. Misoprostol is one of the options for induction in postterm pregnancies, although the choice of induction method may vary based on various factors.
Correct Answer is C
Explanation
Choice A rationale:
A child who has mononucleosis and reports severe fatigue requires medical attention, but this condition does not pose an immediate life-threatening risk compared to acute epiglottitis. Mononucleosis is a viral infection that can cause fatigue, sore throat, and swollen lymph nodes. While the child should be assessed, the priority is given to the child with acute epiglottitis due to the potential for airway obstruction and respiratory distress.
Choice B rationale:
A child who has Wilms' tumor and an abdominal mass also needs urgent medical evaluation. Wilms' tumor is a rare kidney cancer that primarily affects children. While it requires prompt attention, acute epiglottitis poses a more immediate threat to the airway and breathing.
Choice C rationale:
A child with acute epiglottitis and drooling requires immediate assessment and intervention. Acute epiglottitis is a potentially life-threatening infection that can cause severe swelling of the epiglottis, leading to airway obstruction. The child may have difficulty breathing and may present with the classic drooling sign due to the inability to swallow saliva. Prompt medical intervention, including airway management and appropriate antibiotics, is essential in this situation.
Choice D rationale:
A child with a urinary tract infection and bright red blood in her urine requires medical evaluation, but this condition is not as urgent as acute epiglottitis. Hematuria (blood in the urine) can have various causes, including urinary tract infections or kidney stones. While the child should receive medical attention, it does not take precedence over the immediate threat posed by acute epiglottitis, which requires urgent intervention to maintain the airway.
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