Clinical Scenario:

A nurse is assessing a patient who reports joint pain, morning stiffness, and difficulty gripping objects. The nurse observes bony enlargements at the distal and proximal interphalangeal joints of both hands.

Which of the following findings should the nurse document in the patient's assessment?

Tophi deposits and podagra

Heberden's nodes and Bouchard's nodes

Ulnar deviation and joint subluxation

Swan-neck deformity and Boutonnière deformity

Answer and Explanation

The Correct Answer is B

A. Tophi deposits and podagra: These findings are associated with gout, not osteoarthritis. Tophi are urate crystal deposits, and podagra refers to gout affecting the big toe.

B. Heberden's nodes and Bouchard's nodes: Heberden’s nodes are bony growths at the distal interphalangeal (DIP) joints, while Bouchard’s nodes affect the proximal interphalangeal (PIP) joints. These are characteristic of osteoarthritis.

C. Ulnar deviation and joint subluxation: Ulnar deviation and joint subluxation are commonly seen in rheumatoid arthritis, not osteoarthritis.

D. Swan-neck deformity and Boutonnière deformity: These deformities are typical of rheumatoid arthritis, not osteoarthritis.

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Correct Answer is A

Explanation

A. Assess for the presence of pedal pulses and capillary refill time: Compartment syndrome can lead to diminished or absent pulses, delayed capillary refill, and decreased circulation. Assessing pedal pulses and capillary refill is a crucial step in confirming the diagnosis.

B. Measure the patient’s calf circumference and compare it bilaterally: Measuring limb circumference can help assess swelling, but it is not the most critical assessment in this situation. Capillary refill and pedal pulses provide more immediate information about circulation.

C. Ask the patient to flex and extend the affected foot to assess for range of motion: Limited movement can be a sign of compartment syndrome, but if severe pain is already present, further movement may cause more damage. Assessing circulation should be prioritized first.

D. Check for redness and drainage at the pin sites of the external fixation device: Redness and drainage may indicate infection, but this does not directly assess for compartment syndrome. Circulatory assessment is more urgent.

A. Apply an antibiotic ointment and reassess in two weeks. B. Refer the patient to a dermatologist for a biopsy. C. Reassure the patient that the lesion is benign and monitor for changes. D. Educate the patient on proper wound care and sun protection.

Correct Answer is B

Explanation

A. Apply an antibiotic ointment and reassess in two weeks. SCC is a form of skin cancer and requires biopsy for diagnosis. Simply applying an antibiotic and waiting could delay necessary treatment.

B. Refer the patient to a dermatologist for a biopsy. The priority action for a suspicious lesion that does not heal is to refer the patient for biopsy and further evaluation, as early detection and treatment of SCC are crucial.

C. Reassure the patient that the lesion is benign and monitor for changes. SCC can be aggressive if untreated, and assuming benignity without biopsy could result in delayed diagnosis and worsening prognosis.

D. Educate the patient on proper wound care and sun protection. While wound care and sun protection are important, the priority is obtaining a definitive diagnosis through biopsy.

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Naxlex Comprehensive Predictor Exams

Correct Answer is A

Explanation

Correct Answer is B

Explanation

A patient with chronic gout is prescribed allopurinol. Which statement by the patient indicates a correct understanding of the medication's purpose?

A nurse is teaching a patient diagnosed with psoriasis about disease management. Which statement made by the patient indicates a correct understanding of the condition?

A nurse is assessing a patient who sustained partial-thickness burns to the anterior chest and anterior left arm. Using the Rule of Nines, what percentage of total body surface area (TBSA) is affected?

A nurse is providing discharge instructions to the parent of a child diagnosed with impetigo. Which of the following statements by the parent indicates a correct understanding of the treatment plan?

A nurse is caring for a client who has a new short-leg cast on his lower leg to treat an ankle fracture. Which of the following findings requires immediate notification of the provider?

A nurse is caring for a patient post-total hip arthroplasty. Which of the following findings requires immediate intervention?

A nurse is discussing the differences between skeletal and skin traction with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates understanding?

A nurse in the emergency department is caring for a client who has extensive partial and full-thickness burns of the head, neck, and chest. While planning the client's care, the nurse should identify which of the following risks as the priority for assessment and intervention?