The nurse would prioritize which assessment for a client with a new diagnosis of osteoarthritis?
Diet
Skin surrounding the affected joint
Pain
Capillary refill of affected extremity
Range of motion of affected joint
The Correct Answer is C
Choice A reason: Diet is not a priority assessment for a client with osteoarthritis, as it is not a direct cause or consequence of the condition. However, diet may play a role in the management of osteoarthritis, as it can affect the body weight, inflammation, and nutrition of the client.
Choice B reason: Skin surrounding the affected joint is not a priority assessment for a client with osteoarthritis, as it is not a common or serious complication of the condition. However, skin may be affected by the use of heat or cold therapy, topical medications, or joint braces, which may cause irritation, dryness, or infection.
Choice C reason: Pain is a priority assessment for a client with osteoarthritis, as it is the main symptom and the most distressing aspect of the condition. Pain can affect the client's quality of life, mobility, function, and mood. The nurse should assess the location, intensity, frequency, duration, and aggravating or relieving factors of the pain, and provide appropriate interventions to relieve the pain.
Choice D reason: Capillary refill of affected extremity is not a priority assessment for a client with osteoarthritis, as it is not a typical or significant finding of the condition. However, capillary refill may be affected by the circulation, temperature, or hydration of the client, which may influence the healing and recovery of the joint.
Choice E reason: Range of motion of affected joint is not a priority assessment for a client with osteoarthritis, but an important assessment to evaluate the function and mobility of the joint. Osteoarthritis can cause stiffness, swelling, and deformity of the joint, which can limit the range of motion and impair the activities of daily living. The nurse should assess the active and passive range of motion of the joint, and encourage the client to perform regular exercises to maintain the joint health.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Staphylococcus aureus is the most common pathogen to cause osteomyelitis, as it is a gram-positive bacterium that can invade the bone through the bloodstream, a wound, or a surgical site. It can cause acute or chronic inflammation and infection of the bone and bone marrow.
Choice B reason: Escherichia coli is not the most common pathogen to cause osteomyelitis, as it is a gram-negative bacterium that is usually found in the gastrointestinal tract. It can cause urinary tract infections, diarrhea, or sepsis, but it is not a frequent cause of bone infections.
Choice C reason: Proteus mirabilis is not the most common pathogen to cause osteomyelitis, as it is a gram-negative bacterium that is usually found in the urinary tract. It can cause urinary tract infections, kidney stones, or septicemia, but it is not a common cause of bone infections.
Choice D reason: Pseudomonas aeruginosa is not the most common pathogen to cause osteomyelitis, as it is a gram-negative bacterium that is usually found in moist environments. It can cause skin infections, pneumonia, or septic shock, but it is not a frequent cause of bone infections.
Choice E reason: None of the above is not a correct choice, as there is one option that matches the most common pathogen to cause osteomyelitis.
Correct Answer is E
Explanation
Choice A reason: Use of sequential compression devices (SCDs) during times of rest is a helpful intervention to prevent DVT, as it improves the venous return and reduces the stasis of blood in the lower extremities. However, it is not the only or the most effective intervention, as it does not promote the active contraction of the leg muscles.
Choice B reason: Use of abductor pillow while in bed is a necessary intervention to prevent hip dislocation after total hip replacement, as it maintains the alignment and stability of the hip joint. However, it is not a specific intervention to prevent DVT, as it does not enhance the blood circulation or prevent the formation of clots.
Choice C reason: Keeping the heels elevated is a useful intervention to prevent pressure ulcers on the heels, as it reduces the friction and shear forces on the skin. However, it is not a relevant intervention to prevent DVT, as it does not affect the venous flow or prevent the clotting of blood.
Choice D reason: Opioid pain medications as ordered are an important intervention to manage the postoperative pain after total hip replacement, as they provide analgesia and sedation. However, they are not a direct intervention to prevent DVT, as they do not influence the blood coagulation or prevent the thrombus formation. In fact, they may increase the risk of DVT by causing respiratory depression, hypotension, and immobility.
Choice E reason: Early ambulation and leg exercises are the most effective interventions to prevent DVT, as they stimulate the contraction of the leg muscles and improve the blood flow in the veins. They also prevent the pooling and clotting of blood in the lower extremities.
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