HESI CASE STUDY RHEUMATOID ARTHRITISWITH
JOINT ARTHROPLASTY FREQUENTLY TESTED ACTUAL
EXAM QUESTIONS WITH CORRECT ANSWERS
Question 1.
The evening of Terry's second postoperative day, the UAP reports to the nurse that Terry is
complaining of extreme fatigue. She has asked for several additional blankets and told the UAP, "Just
leave me alone. I don't feel good. I'm so cold, and my knees hurt terribly."
Which intervention should the nurse implement first?
ANSWER
A. Instruct the UAP to provide the extra blankets then allow Terry some time to rest before
returning to the room.
B. Assess Terry's pain level then administer a PRN dose of hydrocodone/acetominophen.
C. Assess Terry's vital signs and check the surgical dressings.
D. Instruct the UAP to take Terry's vital signs when she returns to the room.
Rationale: Further assessment of Terry's condition is the highest priority. The nurse should first
assess Terry's vital signs and the appearance of the surgical dressings.
Question 2.
The nurse notifies the healthcare provider and obtains wound and blood cultures. Terry is started on
levofloxacin 750 mg every 24 hours, a primary IV of Ringer's Lactate at 125 mL/hour, and a cooling
blanket. The prescription for levofloxacin is in a 100 mL piggyback bag of 0.9% normal saline. How
many mL/hour would the nurse set the infusion pump on to deliver the IV levofloxacin over 2 hours?
(Enter numerical value only. If rounding is necessary, round to the whole number.)
ANSWER
100 mL/2 hours = 50 mL hour
, Question 3.
On her second postoperative day, Terry's IV is converted to a saline lock, her PCA pump is discontin-
ued, and she is started on hydrocodone/acetaminophen (Lortab) by mouth, every 6 hours PRN. Terry
reports her incisional pain is a 6 on a 10-point scale during her physical therapy, despite receiving her
analgesic prior to the scheduled therapy.
Which professional(s) have prescriptive authority that can provide a prescription for a different
analgesic?
ANSWER
A. Nurse practitioner.
B. Physical therapist.
C. House nursing supervisor.
D. Physician's assistant.
E. Hospital pharmacist.
Rationale: A nurse practitioner, an advanced practiced registered nurse, may legally prescribe
medications either autonomously or as outlined in a collabora- tion practice agreement based
on the state requirements.
A physician's assistant (PA), working in collaboration with a physician, may legally prescribe
medications.
Question 4.
Which adverse effect of methotrexate places Terry at the highest risk for infection?
ANSWER
A. Leukopenia.
B. Anorexia.
C. Thrombocytopenia.
D. Pruritis.
Rationale: Decreased levels of leukocytes place the client at high risk for infection. The client
with leukopenia should be instructed to institute measures to avoid infections.
JOINT ARTHROPLASTY FREQUENTLY TESTED ACTUAL
EXAM QUESTIONS WITH CORRECT ANSWERS
Question 1.
The evening of Terry's second postoperative day, the UAP reports to the nurse that Terry is
complaining of extreme fatigue. She has asked for several additional blankets and told the UAP, "Just
leave me alone. I don't feel good. I'm so cold, and my knees hurt terribly."
Which intervention should the nurse implement first?
ANSWER
A. Instruct the UAP to provide the extra blankets then allow Terry some time to rest before
returning to the room.
B. Assess Terry's pain level then administer a PRN dose of hydrocodone/acetominophen.
C. Assess Terry's vital signs and check the surgical dressings.
D. Instruct the UAP to take Terry's vital signs when she returns to the room.
Rationale: Further assessment of Terry's condition is the highest priority. The nurse should first
assess Terry's vital signs and the appearance of the surgical dressings.
Question 2.
The nurse notifies the healthcare provider and obtains wound and blood cultures. Terry is started on
levofloxacin 750 mg every 24 hours, a primary IV of Ringer's Lactate at 125 mL/hour, and a cooling
blanket. The prescription for levofloxacin is in a 100 mL piggyback bag of 0.9% normal saline. How
many mL/hour would the nurse set the infusion pump on to deliver the IV levofloxacin over 2 hours?
(Enter numerical value only. If rounding is necessary, round to the whole number.)
ANSWER
100 mL/2 hours = 50 mL hour
, Question 3.
On her second postoperative day, Terry's IV is converted to a saline lock, her PCA pump is discontin-
ued, and she is started on hydrocodone/acetaminophen (Lortab) by mouth, every 6 hours PRN. Terry
reports her incisional pain is a 6 on a 10-point scale during her physical therapy, despite receiving her
analgesic prior to the scheduled therapy.
Which professional(s) have prescriptive authority that can provide a prescription for a different
analgesic?
ANSWER
A. Nurse practitioner.
B. Physical therapist.
C. House nursing supervisor.
D. Physician's assistant.
E. Hospital pharmacist.
Rationale: A nurse practitioner, an advanced practiced registered nurse, may legally prescribe
medications either autonomously or as outlined in a collabora- tion practice agreement based
on the state requirements.
A physician's assistant (PA), working in collaboration with a physician, may legally prescribe
medications.
Question 4.
Which adverse effect of methotrexate places Terry at the highest risk for infection?
ANSWER
A. Leukopenia.
B. Anorexia.
C. Thrombocytopenia.
D. Pruritis.
Rationale: Decreased levels of leukocytes place the client at high risk for infection. The client
with leukopenia should be instructed to institute measures to avoid infections.
