The client asks the nurse what nonpharmacological intervention can be used to reduce pain and swelling in her joints affected by rheumatoid arthritis. What is the most appropriate response by the nurse?

Correct Answer: A

Rationale: The most appropriate response by the nurse is option A) "Ice packs can be used to reduce swelling but should be removed after 20 minutes." This is the correct answer because ice packs are recommended for reducing inflammation and swelling in rheumatoid arthritis. The application of ice helps constrict blood vessels, reduce inflammation, and numb the area, providing pain relief. However, leaving ice packs on for too long can lead to tissue damage or skin irritation, hence the instruction to remove them after 20 minutes. Option B is incorrect because while heat can help with pain relief, it is not recommended for reducing swelling in rheumatoid arthritis. Heat can actually exacerbate inflammation in this condition. Option C is incorrect because high impact exercises like running can worsen joint pain and inflammation in rheumatoid arthritis. Low-impact exercises are generally recommended to maintain joint mobility without causing further damage. Option D is incorrect because leaving ice packs on for up to one hour can lead to adverse effects such as frostbite or skin damage. It is important to follow the recommended guidelines for using ice packs to avoid complications. In an educational context, it is crucial for nurses to understand the appropriate nonpharmacological interventions for managing rheumatoid arthritis symptoms. Providing accurate information to clients can help improve their quality of life and promote effective self-management of their condition. Nurses play a key role in educating clients about the safe and effective use of interventions like ice packs to alleviate pain and swelling associated with rheumatoid arthritis.

Correct Answer: A

Rationale: The most appropriate intervention for reducing the risk for a friction and shear injury in an intubated and sedated geriatric client is option A, which is to use a mechanical lift to reposition the client every 2 hours. This intervention is crucial as it helps in redistributing the pressure on the client's body, thereby reducing the risk of pressure ulcers due to friction and shear forces. Repositioning the client with a mechanical lift ensures proper body alignment and minimizes the stress on vulnerable areas, such as bony prominences, which are prone to pressure injuries. Option B, elevating the client's head of the bed to 45 degrees, is not the most appropriate intervention for reducing friction and shear injuries in this scenario. While elevating the head of the bed may have other benefits such as improving ventilation, it does not directly address the risk of pressure injuries caused by friction and shear. Option C, postponing the daily bed bath, is also not the best choice as hygiene is important in preventing infections and maintaining the client's skin integrity. Regular hygiene practices should be maintained while implementing appropriate pressure injury prevention strategies. Option D, where the caregiver independently slides the client up in the bed, is not recommended as it can increase the risk of friction and shear injuries. Improper manual handling techniques can cause friction and shear forces on the client's skin, leading to pressure ulcers. In an educational context, understanding the importance of pressure injury prevention strategies is crucial for healthcare providers caring for vulnerable populations. Proper positioning and repositioning techniques, the use of assistive devices like mechanical lifts, and regular skin assessments are essential components of quality care to prevent pressure injuries in immobilized or sedated patients.

Correct Answer: A

Rationale: In this scenario, the correct action for the nurse to take first is option A) Collect a culture of the purulent fluid. This is crucial as the redness, swelling, and purulent drainage around the pins indicate a possible infection in the area of skeletal traction. Collecting a culture will help identify the specific microorganism causing the infection, which is essential for selecting the most effective antibiotic for treatment. Option B) Cleanse the skin around the pins is incorrect because while maintaining skin integrity is important, addressing the infection by identifying the causative organism takes precedence. Option C) Administer an antibiotic is premature without knowing the specific pathogen causing the infection, as the choice of antibiotic should be guided by culture and sensitivity results. Option D) Instruct the client to complete exercise of the affected extremity is inappropriate at this time as the priority is to address the infection to prevent further complications. Educationally, this question highlights the importance of prioritizing nursing actions based on the assessment findings and understanding the principles of infection control. It also emphasizes the significance of proper wound care, infection management, and the role of diagnostic testing in guiding treatment decisions. Nurses need to have a solid foundation in recognizing signs of infection and implementing appropriate interventions to ensure optimal patient outcomes.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Have client sit in a wheelchair as much as possible. This option increases the risk of pressure injuries because prolonged sitting can lead to pressure points on bony prominences, especially if the individual is unable to shift their weight or change positions frequently. This can result in decreased blood flow to the area, leading to tissue damage and the development of pressure injuries. Option A) Padding hard surfaces is actually a preventive measure that reduces the risk of pressure injuries by providing cushioning and reducing pressure on bony areas. Option C) Placing pillows between bony surfaces is also a recommended nursing intervention to prevent pressure injuries by reducing pressure and friction on vulnerable areas. Option D) Keeping the head of the bed at or less than 30 degrees is a measure to prevent aspiration in patients at risk of choking or aspiration pneumonia, and it is not directly related to the development of pressure injuries. Educationally, understanding the risk factors and preventive measures for pressure injuries is crucial for nurses caring for patients with limited mobility. It is essential to promote frequent repositioning, proper support surfaces, and pressure-relieving devices to mitigate the risk of pressure injuries and provide optimal care for patients at risk.

Correct Answer: C

Rationale: In this scenario, the nurse suspects the skin abnormality to be psoriasis. Psoriasis is a chronic autoimmune condition that speeds up the growth cycle of skin cells, leading to the formation of thick, red patches with silvery scales, commonly seen on elbows and knees. Option A, scabies, is a parasitic infestation characterized by intense itching and burrow tracks on the skin, not thick red patches with silvery scales. Option B, rosacea, is a chronic skin condition causing redness and visible blood vessels, typically on the face, not thick red patches with silvery scales on elbows and knees. Option D, stasis dermatitis, is a skin condition related to poor circulation and typically presents as swollen, discolored skin on the lower legs, not as thick red patches with silvery scales. Educationally, it is crucial for healthcare professionals to recognize common skin abnormalities like psoriasis to provide appropriate care and referrals. Understanding the distinguishing features of different skin conditions helps in accurate diagnosis and management, ensuring optimal patient outcomes. Early identification of psoriasis can lead to timely interventions and improved quality of life for the client.