Chapter 46: Concepts of Care for Patients
with Arthritis and Total Joint Arthroplasty
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. A client asks the nurse about having a total knee arthroplasty to relieve joint pain.
Which factor would place the client at the highest risk for impaired postoperative
healing?
a. Controlled hypertension
b. Obesity
c. Osteoarthritis
d. Mild osteopenia
ANS: B
Obesity places a client at high risk for many postoperative complications including
slower wound and bone healing. The other factors usually do not affect healing after
surgery.
DIF: Understanding TOP: Integrated Process: Nursing Process: Assessment
KEY: Total knee arthroplasty, Perioperative care MSC: Client
Needs Category: Physiological Integrity: Physiological Adaptation
2. A nurse assesses a group of clients who have rheumatoid arthritis (RA). Which client
would the nurse see first?
a. Client who reports jaw pain when eating
b. Client with a red, hot, swollen right wrist
c. Client who has a puffy-looking area behind the knee
, d. Client with a worse joint deformity since the last visit
ANS: B
All of the options are possible manifestations of RA. However, the presence of one
joint that is much redder, hotter, or more swollen that the other joints may indicate
infection or an exacerbation of the RA disease process. The nurse needs to see this
client first.
DIF: Analyzing TOP: Integrated Process: Nursing Process: Assessment
KEY: Rheumatoid arthritis, Signs and symptoms MSC: Client
Needs Category: Safe and Effective Care Environment: Management of Care
3. The nurse assesses a client with rheumatoid arthritis (RA) and Sjögren syndrome.
What assessment would be most important for this client?
a. Abdominal assessment
b. Oxygen saturation
c. Breath sounds
d. Visual acuity
ANS: D
Sjögren syndrome may be seen in clients with RA and manifests with dryness of the
eyes, mouth, and vagina in females. Visual disturbances can occur. The other
assessments are not related to Sjögren syndrome.
DIF: Applying TOP: Integrated Process: Nursing Process: Assessment
KEY: Rheumatoid arthritis, Nursing assessment MSC: Client
Needs Category: Physiological Integrity: Reduction of Risk Potential
4. A client who has rheumatoid arthritis is prescribed etanercept. What health teaching
by the nurse about this drug is appropriate?
a. Giving subcutaneous injections
b. Having a chest x-ray once a year
, c. Taking the medication with food
d. Using heat on the injection site
ANS: A
Etanercept is given as a subcutaneous injection twice a week. The nurse would teach
the client how to self-administer the medication. The other options are not appropriate
for etanercept.
DIF: Understanding TOP: Integrated Process: Teaching/Learning
KEY: Rheumatoid arthritis, Drug therapy MSC: Client
Needs Category: Physiological Integrity: Pharmacological and Parenteral
Therapy
5. A client with rheumatoid arthritis (RA) has an acutely swollen, red, and painful joint.
What nonpharmacologic intervention does the nurse recommend?
a. Heating pad
b. Ice packs
c. Splint
d. Paraffin dip
ANS: B
Ice is best for acute inflammation. Heat often helps with joint stiffness. Splinting
helps preserve joint function. A paraffin dip is used to provide warmth to the joint
which is more appropriate for chronic pain and stiffness.
DIF: Understanding TOP: Integrated Process: Nursing Process:
Implementation KEY: Rheumatoid arthritis, Pain management
MSC: Client Needs Category: Physiological Integrity: Basic Care and
Comfort
6. A client is scheduled to have a total hip arthroplasty. What preoperative teaching by
the nurse is most important?
with Arthritis and Total Joint Arthroplasty
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. A client asks the nurse about having a total knee arthroplasty to relieve joint pain.
Which factor would place the client at the highest risk for impaired postoperative
healing?
a. Controlled hypertension
b. Obesity
c. Osteoarthritis
d. Mild osteopenia
ANS: B
Obesity places a client at high risk for many postoperative complications including
slower wound and bone healing. The other factors usually do not affect healing after
surgery.
DIF: Understanding TOP: Integrated Process: Nursing Process: Assessment
KEY: Total knee arthroplasty, Perioperative care MSC: Client
Needs Category: Physiological Integrity: Physiological Adaptation
2. A nurse assesses a group of clients who have rheumatoid arthritis (RA). Which client
would the nurse see first?
a. Client who reports jaw pain when eating
b. Client with a red, hot, swollen right wrist
c. Client who has a puffy-looking area behind the knee
, d. Client with a worse joint deformity since the last visit
ANS: B
All of the options are possible manifestations of RA. However, the presence of one
joint that is much redder, hotter, or more swollen that the other joints may indicate
infection or an exacerbation of the RA disease process. The nurse needs to see this
client first.
DIF: Analyzing TOP: Integrated Process: Nursing Process: Assessment
KEY: Rheumatoid arthritis, Signs and symptoms MSC: Client
Needs Category: Safe and Effective Care Environment: Management of Care
3. The nurse assesses a client with rheumatoid arthritis (RA) and Sjögren syndrome.
What assessment would be most important for this client?
a. Abdominal assessment
b. Oxygen saturation
c. Breath sounds
d. Visual acuity
ANS: D
Sjögren syndrome may be seen in clients with RA and manifests with dryness of the
eyes, mouth, and vagina in females. Visual disturbances can occur. The other
assessments are not related to Sjögren syndrome.
DIF: Applying TOP: Integrated Process: Nursing Process: Assessment
KEY: Rheumatoid arthritis, Nursing assessment MSC: Client
Needs Category: Physiological Integrity: Reduction of Risk Potential
4. A client who has rheumatoid arthritis is prescribed etanercept. What health teaching
by the nurse about this drug is appropriate?
a. Giving subcutaneous injections
b. Having a chest x-ray once a year
, c. Taking the medication with food
d. Using heat on the injection site
ANS: A
Etanercept is given as a subcutaneous injection twice a week. The nurse would teach
the client how to self-administer the medication. The other options are not appropriate
for etanercept.
DIF: Understanding TOP: Integrated Process: Teaching/Learning
KEY: Rheumatoid arthritis, Drug therapy MSC: Client
Needs Category: Physiological Integrity: Pharmacological and Parenteral
Therapy
5. A client with rheumatoid arthritis (RA) has an acutely swollen, red, and painful joint.
What nonpharmacologic intervention does the nurse recommend?
a. Heating pad
b. Ice packs
c. Splint
d. Paraffin dip
ANS: B
Ice is best for acute inflammation. Heat often helps with joint stiffness. Splinting
helps preserve joint function. A paraffin dip is used to provide warmth to the joint
which is more appropriate for chronic pain and stiffness.
DIF: Understanding TOP: Integrated Process: Nursing Process:
Implementation KEY: Rheumatoid arthritis, Pain management
MSC: Client Needs Category: Physiological Integrity: Basic Care and
Comfort
6. A client is scheduled to have a total hip arthroplasty. What preoperative teaching by
the nurse is most important?
