HESI Case Study – Rheumatoid Arthritis with Joint Arthroplasty

Which nursing intervention related to the scheduled bone scan is most important to implement?
D) Instruct Terry to increase fluid intake after the test
Which etiologic factor is related to the onset of rheumatoid arthritis?
B) Genetic Predisposition
In addition to the bilateral swollen tender joints, weight loss, and fatigue, what additional manifestation(s) of RA might Terry exhibit?
B) Joint deformities
D) Fever
E) Stiffness
Which assessment findings may indicate aspirin toxicity?
D) Ringing in the ears and confusion
E) Heartburn, bloating, and nausea
Which adverse effect of methotrexate places Terry at the highest risk for infection?
A) Neutropenia
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Which information should be included when teaching Terry how to manager her chronic pain?
B) Apply warm packs to affected joints
E) Topical analgesics
Which nursing intervention is best to implement for this nursing diagnosis?
D) Instruct Terry regarding the use of joint splints
Which nursing intervention will promote improved coping for Terry?
D) Help Terry practice problem-solving techniques
What is the nurse’s best response?
A) You seem very overwhelmed right now
What is the nurse’s best response to this remark?
B) Have you considered the possibility of surgical joint replacement?
What is the best definition of arthroplasty?
B) Surgical joint replacement
Which postoperative intervention should the nurse expect to implement?
D) Empty drainage from the suction device and record the output
Which assessment finding should be reported to the healthcare provider?
B) Presence of paresthesia bilaterally
Which instruction should the nurse include when teaching Terry about the PCA pump?
B) The pump is set to prevent you from receiving an overdose
Which intervention should the nurse implement first?
B) Assess Terry and rule out any possible complications
Which tasks can be delegated to the UAP?
B) Empty Terry’s catheter drainage bag and record her urinary output
E) Obtain and record vital signs
Which professionals have prescriptive authority that can provide a prescription for a different analgesic?
A) Nurse practitioner
D) Physician’s assistant
What is the best nursing action in response to this prescription?
C) Contact the PA for clarification of this incomplete prescription
Which intervention should the nurse implement first?
C) Assess Terry’s vital signs, including her temperature
Which intervention should the nurse prepare to implement?
A) Obtain wound and blood cultures
Which manifestations may indicate the onset of septic shock?
B) Increased pulse rate
C) Restlessness
The prescription for gentamicin (Garamycin) is in a 50 mL piggyback bag of 0.9% normal saline. How many mL/hour would the nurse set the infusion pump on to deliver the IV gentamicin (Garamycin) over 30 minutes? (Enter numerical value only. If rounding is necessary, round to the whole number.)

rationalle: 50 mL/30 minutes = X mL/60 minutes
300 = 30X
X = 100 mL hour

Which outcome is most important for this portion of the teaching plan?
D) Terry demonstrates the correct use of crutches for ambulation and transfers
Which positioning indicates that the crutches are sized correctly?
B) Arms flexed 20 degrees, crutch top two finger-widths from axilla
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