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med surge 2 exam 2
| Question | Answer |
|---|---|
| how would you test for Tinel's sign to diagnose carpel tunnel syndrome | have the client hold the palm of the hand up while the nurse percuss over the median nerve |
| positive Tinel's sign | reports tingling, numbness, pain after the percussing light over the median nerve located on the inner aspect of the wrist |
| after menopause the loss of ________ leads to a loss of bone density and a loss of height | Estrogen |
| calcitonin | inhibits bone resorption and promotes bone formation |
| Estrogen | inhibits bone breakdown and also decrease with age |
| Bisphosphonates medications | Alendronate, Ibandronate, Zoledronic Acid |
| disease result in an slowly progressive contracture, abnormal shortening of the palmar fascia that causes flexion of the fourth, fifth and sometimes middle finger | Dupuytren Disease |
| discharge instructions for a client with osteomyelitis include | 3 to 6 weeks of IV antibiotics |
| when educating the client on proper lifting techniques the nurse includes | placing the load close to the body |
| what is included in the teaching for a client diagnosed with plantar fasciitis | stretching exercises, wearing shoes with support and cushioning to relieve pain, orthotic devices (heel cups, arch supports, night splints) corticosteroids injections |
| what is a major complication of osteoporosis | bone fracture |
| what position can the nurse suggest for the patient with low back pain | supine, with the knees slightly flexed and the head of the bed elevated at least 30 degrees (lumbar flexion) |
| Morton neuroma is exhibited by which clinical manifestation | swelling of the third lateral branch of the median plantar nerve |
| a client has osteomyelitis is receiving antibiotics with no wound improvement what action would the nurse implement next | surgical debridement |
| small frame women are greatest risk for | osteoporosis |
| in terms of ethnicity which group has the greater risk | Asian and Caucasian women |
| while talking with a client you hear audible clicking when the client is moving the jaw what will the nurse suspect | temporomandibular disorder |
| what teaching point is correct with preventing osteoporosis | the recommended daily allowance of calcium may found in a wide variety of foods |
| appropriate diagnosis for Paget disease | risk falls |
| surgical procedure that allows direct visualization of the extent of joint damage | arthroscopy |
| dangerous complication of bone cancer | hypercalcemia |
| benign bone tumors that may undergo malignant transformation and metastasize | Giant cell tumors (osteoclastomas) |
| the most common sites of tumors that metastasize to the bone | kidney, prostate, lung, breast ovary, thyroid |
| primary organism that causes osteomyelitis | staphylococcus aureus |
| patient who are high risked for osteomyelitis | older adults who are poorly malnourished, obese, impaired immune, chronic illness, long term use corticosteroids |
| appropriate amount of calcium for older adults | 1200 mg daily |
| priority intervention after foot surgery | neurovascular assessment of the exposed toes every 1 to 2 hours for the first 24 hours. it is essential to monitor the function of the nerves and the perfusion of the tissues |
| what is another name for hallux vagus | bunion. deformity in which the great toe deviates laterally |
| thickened are of the skin that has been exposed to persistent pressure or friction | callus |
| 5 musculoskeletal problems that can cause lower back pain | acute lumbosacral strain, unstable lumbosacral ligaments, weak muscles, intervertebral disc problems, and unequal leg length |
| identify the time frame for chronic back pain | 3 months or longer with out improvement |
| identify acute back pain | fewer than 3 months |
| patient report pain radiating down the leg which is known as | radiculopathy |
| what position to avoided during low back pain | prone position because it accentuates lordosis |
| patient experiencing lower back pain, which position will the nurse recommend to relieve discomfort | supine with the knees slightly flexed and the head of the bed elevated 30 degrees |
| the nurse is educating a patient with low back about the proper way to lift objects. which muscle will the nurse encourage the patient to maximize? | quadriceps |
| carpel tunnel syndrome | a neuropathy that is characterized when the median nerve is compressed at the wrist by a thickened flexor tendon sheath, skeletal encroachment, edema or soft tissue mass |
| what is the cause of osteomalacia | inadequate mineralization of the bone |
| skeleton soften and weakens, causing pain, tenderness to touch, bowing of the bones, and pathological fractures | signs of osteomalacia |
| the major defect in osteomalacia | Deficiency of activated vitamin D, which promotes calcium absorption of the GI tract and facilitates mineralization of the bone |
| Piaget disease (osteitis deformans) | rapid bone turnover. most commonly affecting the skull, femur, tibia, pelvic bones and vertebrae |
| patient diagnosed with osteogenic sarcoma which laboratory studies will the nurse for? | ALP (alkaline phosphates) |
| the nurse caring for a patient with bone metastasis from primary breast cancer reports muscle weakness, nausea, and is voiding large amounts frequently with cardiac arrhythmias present. which does the nurse suspect based on these clinical findings | hypercalcemia |
| when is a metastatic bone tumor is diagnosed | only after a pathologic fracture or incidental finding |
| injury that occur to a muscle or tendon from overuse, overstretching, or excessive stress | strain commonly known as muscle pull |
| an injury to the ligaments and tendons that surround a joint, is caused by twisting motion or hyperextension (forcible) of joint | sprain |
| to control pain, bleeding, and inflammation, most contusions, sprains, strains are managed with | R (rest), I (ice), C(compression), E(elevation) |
| following a arthroplasty (total hip replacement) when should the patient begin ambulation with assistive devices such as walker or crutches? | 24hrs after surgery |
| leading cause of musculoskeletal related disabilities | arthritis |
| approximately ________ mg of calcium daily is essential to maintain adult bones | 1000 - 1200 mg |
| red bone marrow is located in the shaft of four long and flat bones | sternum, ilium, vertebrae, ribs |
| major hormonal regulator of calcium homeostasis | PTH, calcitonin |
| crepitus | describe the grating, crackling sound heard over irregular joint surfaces like the knee |
| stimulates osteoblasts and inhibit osteoclast | estrogen |
| direct or indirect growth causing skeletal growth | testosterone |
| shortening of the muscle without increase tension | isotonic |
| length of muscle remain constant, force generated by muscle increase | isometric |
| kyphosis | increase curvature of the thoracic spine (hunch back) |
| sway back curvature of the spine | scoliosis |
| how would the nurse detect effusion? | Ballottement test, common site is the knee, joint motion is compromised and painful |
| what procedure allow the provider to remove fluid from the knee | arthrocentesis |
| muscle that is limb without tone | flaccidity |
| soft and flabby muscle | atonic |
| abnormal sensations such as tingling, numbness, burning sensation | paresthesia |
| when assessing reflexes of the ankle the nurse observes rhythmic contractions of the muscle when dorsiflexing the foot | clonus |
| a partial or incomplete dislocation and does not cause as much deformity as a complete dislocation | subluxation |
| if a dislocation or subluxation is not reduced immediately ______ may develop | avascular necrosis |
| avascular necrosis of the bone is caused by | ischemia which leads to necrosis or death of the bone cell |
| stabilize the humeral head and keeps the arm in the shoulder socket | rotator cuff |
| involves damage to the skin and mucus membrane and is also called an open fracture | compound fracture |
| to prevent complications of hip fracture the nurse should encourage | fluid intake, ankle and foot exercise. also anti - embolism stockings, pneumatic compression devices and prophylactic anticoagulant are indicated and should be prescribed |
| external fixation | bandages, cast, splints, continuous tractions |
| internal fixation | metallic pins, wires, screws, plates, nails,rods |
| complications of a missed acute compartment syndrome of the arm | Volkmann ischemic contracture |
| hallmark sign of compartment syndrome | pain |
| Nonunion | incomplete healing of a fracture and result from failure of the ends of a fractured bone to unite (inadequate immobilization) |
| delayed union | when healing does not occur in the expected time frame (distraction pulling apart bone fragment, local infection, poor nutrition, comorbidity) |
| malunion | the healing of a fractured bone in a misaligned deformed |
| which shock is associated with hip fracture | hypovolemic shock |
| patient with an open fracture is at risk for what 3 major complications | osteomyelitis, tetanus, gas gangrene |
| what are common pulmonary complications for older adult patient following a hip fracture | pneumonia, atelectasis |
| a muscle tear that is microscopic and due to over use is called a | strain |
| a residual limb should never be placed on a pillow to avoid | flexion contraction |
| an injury to the ligaments and tendons that surround a joint. it is caused by a twisting motion or hyperextension (forcible) of a joint | sprain |
| patient with humeral neck fraction are advised healing usually take approximately | 6-10 weeks with restricted vigorous activity |
| three early complications of a fraction | shock, fat embolism, acute compartment syndrome |
| three delayed complications of a fraction | pulling apart of bone fragments, local or system infection, poor nutrition or comorbidity |
| a patient in early shock from a fracture, what five activities are involved in treatment | stabilizing the fracture to prevent further hemorrhage, restoring blood volume and circulation, relieve the patient's pain, providing proper immobilization and protecting the patient from further complication |
| a break occurs across the entire section of the bone | complete fracture |
| a fragment of the bone is pulled off by a ligament or tendon | Avulsion fracture |
| bone is splintered into several fragments | comminuted fracture |
| One side of the bone is broken and the other side is bent | greenstick fracture |
| a fracture that occurs through the epiphysis | epiphyseal fracture |
| priority intervention for a patient with a rib fracture reporting pain with inspiration | coughing and deep breathing with pillow splinting |
| common complication after a fracture of the femoral shaft | restriction of knee movement |
| pulmonary complications _______ are a great threat to older patients undergoing hip surgery | atelectasis and pneumonia |
| standard method in turning a patient with a hip fracture | most comfortable and safest way is to turn the patient on the unaffected side. involves placing a pillow between the patients legs to keep the affected leg in abduction position |
| the nurse encourage the patient to use _______ this device helps strengthen the arms and shoulders in preparation for protected ambulation | overbed trapeze |
| to of the most serious consequences that occur with a pelvic fracture | hemorrhage and shock |
| fractures of the distal radius (colles fracture) are most common | fall on open, outstretched hand, with wrist in extension |
| a fracture which a bone fragment is driven into another bone fragments | impacted fracture |
| fracture in which bone has been compressed | compression fracture |
| fracture in which fragments are driven inward (skull and fascial bones) | depressed fracture |
| fracture occurring at an angle | oblique fracture |
| a fracture in which damage also involves the skin and mucous membrane | open and compound fracture |
| a fracture that occurs through an area of diseased bones (osteoporosis, bone cyst, paget disease, bony metastasis, tumor) | pathologic fracture |
| a fracture that twists around the shaft of the bone | spiral fracture |
| fracture that remains contained with no disruption of the skin integrity | simple fracture |
| a fracture straight across the bone shaft | transverse fracture |
| three leading cause of death in men | lung, prostate, colorectal |
| three leading cause of death in women | lung, breast, colorectal |
| example of primary prevention of cancer | the use of immunization to reduce the risk of cancer through prevention of infections associated with cancer (HPV vaccine) |
| secondary prevention | involves screening and early detection activates that seek to identify precancerous lesions and early stage cancer in individuals who lack signs and symptoms |
| tertiary prevention | focus on monitoring and preventing recurrence of the primary cancer as well as screening for the development of second malignancies in cancer survivors |
| Myelosuppression caused by chemotherapeutic agents result in | leukopenia, neutropenia, anemia, thrombocytopenia and increased risk of infection and bleeding (depression in the bone marrow) |
| three chemotherapeutic agents that are particularly toxic to the renal system are? | cisplatin, methotrexate, mitomycin |
| single most lethal chemical carcinogen counts for 30% of all cancer related deaths | tobacco |
| tow of the most common side effects of chemotherapy | Nausea and vomiting lasting which may persist for about 24 to 48n hours |
| what are the different biopsy methods | excisional, incisional and biopsy |
| incisional biopsy | is performed if the tumor mass is too large to be removed. a wedge of tissue from the tumor is removed for analysis |
| biopsy method | is determined by the size, location of the tumor, the type of treatment anticipated if the cancer diagnosis is confirmed and the need for surgery. the least invasive approach while permitting the most representative tissue sample chosen |
| excisional biopsy | used for small, easily accessible tumors, surgeon can remove the entire tissue as well as the surrounding marginal tissue |
| which is a growth based classification of tumors | malignancy |
| extravasation | occurs when medication leaks into the surrounding tissue site causing pain, swelling and burning at the injection site |
| vesicants | are agents that cause inflammation, tissue damage, and possibly necrosis of the tendons, muscles, nerves, and blood vessels if extravasation |
| a woman with a total hysterectomy should stop | cervical cancer screening |
| HPV DNA testing | only for abnormal pap test |
| women 21-29 | screening should be done every 3 years wit conventional or liquid base pap tests |
| women 30 -65 | screening should be done every 5 years with HPV and pap test and every 3 years with pap test alone |
| women 66+ | who have regular cervical cancer screening with negative results should stop cervical cancer screenings |
| indications of extravasation during administration of vesicant agents | absence of blood return from the IV catheter, resistance to flow of IV fluid, burning or pain, swelling, redness at the site |
| which type of vaccine uses the client own cancer cells, which are killed and prepared to be injected back in to the patient | autologous |
| allogeneic | are made from cancer cell lines that are immortalized cells that were originally obtained other people who had a specific type of cancer. these cancer cells are grown in a laboratory and eventually killed and prepared for injection |
| prophylactic | prevent disease |
| three vaccines approved by the FDA for the prevention of HPV | HPV2 (females only, types 16 and 18), HPV4 (both genders and types 6,11,16,18) HPV9 (both genders, for 9 types associates with cervical, anal, vaginal, and vulvar cancer, genital warts) |
| benign | noncancerous |
| malignant | cancerous |
| two examples of tumor specific antigens in altered cell membranes of malignant cells | carcinogens and angiogenesis |
| heavy alcohol uses increases the risk of cancers of the | mouth, pharynx, larynx, esophagus, liver, colon, rectum, and breast |
| dietary substances that increases the risk of cancer | fats, alcohol, salt - cured or smoked meats, nitrate or nitrate containing foods, red processed meats |
| debulking procedure | removing the entire tumor or as much as feasible including surrounding tissue including regional lymph nodes |
| accumulation of fluid in the pericardia space | cardiac tamponade |
| Tis | carcinoma in situ |
| which contraceptive is recommended for an HIV positive patient | the female condom, provides a physical barrier that prevents exposure to genital secretions containing HIV, such as semen and vaginal fluid |
| CD+4 levels are measured to determine | CD4 levels in the blood of individual with HIV infection determine the extent of the damage to the HIV positive patient |
| HIV is transmitted through which body fluids? | blood, seminal fluid, vaginal secretions, amniotic fluid, breast milk |
| which cell is HIV harbored in? | lymphocytes |
| which results indicate that the patient has an allergic disorder | high IgE concentration |
| what does allergic disorder mean | it is a hyperimmune response to something in the environment that is usually harmless |
| when assessing the skin of a patient with allergic contact dermatitis, where would the nurse most likely to expect to find the irritation where? | the dorsal part of the hand |
| food allergy is what type of hypersensitivity | type 1 hypersensitivity IgE |
| what type pf reaction is anaphylaxis | type 1 hypersensitivity IgE |
| A client develops a facial rash and urticaria after receiving penicillin. Which laboratory value does the nurse expect to be elevated? | IgE |
| What are the five immunoglobulin | IgG, IgM, IgA, IgD, IgE |
| What type of immunoglobulin is most likely involved with allergic reactions? | IgE |
| Which body substance causes increased gastric secretion, dilation of capillaries, and constriction of the bronchial smooth muscle? | Histamine |
| The clinic nurse is caring for a client with an allergic disorder who has received the first sensitizing dose of a new drug. Now, the client is given a second dose. What nursing action is most important at this stage of transition? | Monitor the client for reactions. |
| The nurse is preparing to administer a medication that has an affinity for H1 receptors. Which medication would the nurse administer? | Diphenhydramine |
| A patient is experiencing an allergic reaction to a dose of penicillin. What should the nurse look for in the patient’s initial assessment? | Dyspnea, bronchospasm, and/or laryngeal edema. |
| The nurse is teaching a client about allergic rhinitis and its triggers. What is the most common trigger for the respiratory allergic response? | plant pollen |
| What is the most common cause of anaphylaxis? | Penicillin |
| Which of the following is the most frequent route of exposure to a latex allergy? | Cutaneous |
| A client reports to a health care provider's office for intradermal allergy testing. Before testing, the nurse provides client teaching. Which client statement indicates a need for further education? | "If I notice tingling in my lips or mouth, gargling may help the symptoms." |
| What is the most common cause of anaphylaxis? | Penicillin |
| A nurse is working in a dermatology clinic with clients who have allergies. What is the most important chemical mediator involved in the allergic response? | histamine |
| The nurse tells the client that if exposure to an allergen occurs around 8:00 AM, then the client should expect a mild or moderate reaction by what time? | 10:00am |
| An infant is born to a mother who had no prenatal care during her pregnancy. What type of hypersensitivity reaction does the nurse understand may have occurred? | Rh-hemolytic disease |
| A client calls the clinic and asks the nurse if using oxymetazoline nasal spray would be all right to relieve the nasal congestion the client is experiencing due to seasonal allergies. What instructions should the nurse provide to the client to avoid comp | Taper the dose when discontinuing the medication. |
| The client presents to the emergency department with a suspected allergic reaction to the antibiotic they were given at the quick care clinic to treat their pneumonia. What are the priority actions the nurse should take? Select all that apply. | Insert an intravenous line, Take vital signs, Place oxygen on the client. |
| The nurse is teaching a group of health care workers about latex allergies. What reaction will the nurse teach the workers to be most concerned about with laryngeal edema? | IgE-mediated hypersensitivity |
| A patient was seen in the clinic 3 days previously for allergic rhinitis and was given a prescription for a corticosteroid nasal spray. The patient calls the clinic and tells the nurse that the nasal spray is not working. What is the best response by the | “The full benefit of the medication may take up to 2 weeks to be achieved.” |
| Which term refers to an incomplete antigen? | Hapten |
| The nurse observes diffuse swelling involving the deeper skin layers in a client who has experienced an allergic reaction. The nurse would correctly document this finding as | angioneurotic edema. |
| What education should the nurse provide to the patient taking long-term corticosteroids? | The patient should not stop taking the medication abruptly and should be weaned off of the medication. |
| Which allergic reaction is potentially life threatening? | angioedema |
| A client with an allergic disorder calls the nurse and asks what treatment is available for allergic disorders. The nurse explains to the client that there is more than one treatment available. What treatments would the nurse tell the client about? | Desensitization |
| Which intervention is the single most important aspect for the client at risk for anaphylaxis? | Prevention |
| The nurse is interviewing a client being admitted to the hospital and inquires about any allergies the client has. The client states being allergic to aspirin and penicillin. What intervention should the nurse provide immediately to prevent complications | Apply an allergy bracelet and flag the chart |
| The maximum intensity of histamine occurs within which time frame after contact with an antigen? | 5 to 10 minutes |
| The nurse is working with a colleague who has a delayed hypersensitivity (type IV) allergic reaction to latex. Which statement describes the clinical manifestations of this reaction? | Symptoms are localized to the area of exposure, usually the back of the hands. |
| A nurse comes to the employee health center for evaluation and is diagnosed with allergic contact dermatitis related to latex. What manifestation would the nurse most likely exhibit? | Blistering |
| A nurse is reviewing the dietary history of a client who has experienced anaphylaxis. What would the nurse identify as a common cause of anaphylaxis? Select all that apply. | Milk, Eggs, Shrimp |
| The nurse explains to a client that immunotherapy initially starts with injections at which interval? | Weekly |
| A client with lupus has had antineoplastic drugs prescribed. Why would the physician prescribe antineoplastic drugs for an autoimmune disorder? | For their immunosuppressant effects |
| A client has begun sensitivity testing to determine the allergen which caused an anaphylactic reaction 3 weeks ago. In scratch testing, which part of the body is more sensitive to allergens? | back |
| The nurse is teaching a client about contact dermatitis. What type of contact dermatitis requires light exposure in addition to allergen contact? | photoallergic |
| The parents of a child with contact dermatitis are asking questions about the reaction within the immune system. What description regarding contact dermatitis as a type IV hypersensitivity reaction is accurate? | a delayed-type hypersensitivity that is mediated by T cells |
| A client is presenting an anaphylactic response to unknowingly ingesting nuts at a family celebration. What type of hypersensitivity did this client exhibit? | type I |
| The nurse working in an allergy clinic is preparing to administer skin testing to a client. Which route is the safest for the nurse to use to administer the solution? | Intradermal |
| In its attempt to suppress allergic responses, the body releases several chemicals which have a role in mediating physical reactions. Epinephrine, which interferes with vasoactive chemical release from mast cells, is instrumental in suppressing which type | type I |
| The nurse is teaching a client newly diagnosed with a peanut allergy about how to manage the allergy. What information should be included in the teaching? Select all that apply. | Wear a medic alert bracelet, List symptoms of peanut allergy, Identify ways to manage allergy while dining out, Carry EpiPen autoinjector at all times. |
| The parents of a child with contact dermatitis are asking questions about the reaction within the immune system. What description regarding contact dermatitis as a type IV hypersensitivity reaction is accurate? | a delayed-type hypersensitivity that is mediated by T cells |
| A nurse is teaching a client how to use their EpiPen autoinjector. What client statement indicates the teaching is understood? Select all that apply. | The EpiPen autoinjector needs to be pointed downward.” The needle needs to be at a 90-degree angle.” “After I administer the injection, I will massage the area for 10 seconds.” |
| A client with a history of anaphylactic reactions to insect stings has just been stung by a wasp. Place the steps in the correct order that the client will follow for self-administration of an EpiPen. Use all options. | Remove the gray safety-release cap Inject the black tip into the outer thigh Massage the injection area Call the emergency medical response number (911) |
| A nurse is reviewing the dietary history of a client who has experienced anaphylaxis. What would the nurse identify as a common cause of anaphylaxis? Select all that apply. | Milk Eggs Shrimp |
| The nurse teaches the client with allergies about anaphylaxis, including which statement? | The most common cause of anaphylaxis is penicillin. |
| Which chemical mediators initiate and mediate the inflammatory response? | Leukotrienes |
| Which statement describes the clinical manifestations of a delayed hypersensitivity (type IV) allergic reaction to latex? | They are localized to the area of exposure, usually the back of the hands. |
| A nurse knows to advise a patient who is taking Atarax, an over-the-counter (OTC) antihistamine, to be aware of the serious potential side effect of | Seizures. |
| The nurse is working in an allergy clinic with a client with tuberculosis. What other reaction is a type IV hypersensitivity disorder? | contact dermatitis |
| The nurse is teaching a client about histamine release during an anaphylactic reaction. What does histamine release in anaphylaxis cause? | nasal congestion |
| A client comes to the clinic with a rash. While inspecting the client's skin, the nurse determines that the rash is medication-related based on which finding? | Rash has several large raised areas |
| A nurse is assessing a client who is experiencing an allergic reaction. What will the nurse identify as resulting from the release of histamine? | Pruritus |
| A nurse is teaching a client who is allergic to ragweed. What season does the nurse advise the client to expect an increase in symptoms? | early fall |
| A patient received epinephrine in response to an anaphylactic reaction at 10:00 AM. The nurse knows to observe the patient for a “rebound” reaction that may occur as early as: | 2:00 PM. |
| Maximum intensity of histamine occurs within which time frame following antigen contact? | 15 minutes |
| The nurse is working in an allergy clinic with a client with tuberculosis. What other reaction is a type IV hypersensitivity disorder? | contact dermatitis |
| While interviewing a client with an allergic disorder, the client tells the nurse about an allergy to animal dander. The nurse knows that animal dander is what type of substance? | Complete protein antigen |
| The client presents to the health care provider's office with an allergic reaction. The health care provider documents the client's condition as a nonatopic, IgE-mediated response. What allergic reaction is this client experiencing? | A latex allergy |
| The nurse is teaching a client with allergic rhinitis about medications. What medication is a mast cell stabilizer used in the treatment of allergic rhinitis? | intranasal cromolyn sodium |
| Atopic allergic disorders are characterized by | a hereditary predisposition |
| A patient is suspected of having rheumatoid arthritis and her diagnostic regimen includes aspiration of synovial fluid from the knee for a definitive diagnosis. The nurse knows that which of the following procedures will be involved? | Arthocentesis |
| A nurse is providing care for a patient who has just been diagnosed as being in the early stage of rheumatoid arthritis. The nurse should anticipate the administration of which of the following? | Methotrexate (Rheumatrex) |
| A nurse is performing the initial assessment of a patient who has a recent diagnosis of systemic lupus erythematosus (SLE). What skin manifestation would the nurse expect to observe on inspection? | An acute cutaneous lesion consisting of a butterfly-shaped rash across the bridge of the nose and cheeks |
| less commonly affected by systemic lupus | gastrointestinal tract, liver as well as ocular system |
| A clinic nurse is caring for a patient with suspected gout. While explaining the pathophysiology of gout to the patient, the nurse should describe which of the following? | Increased uric acid levels |
| A patients decreased mobility is ultimately the result of an autoimmune reaction originating in the synovial tissue, which caused the formation of pannus. This patient has been diagnosed with what health problem? | Rheumatoid arthritis (RA) |
| What assessment finding is most consistent with the clinical presentation of RA? | Joint stiffness, especially in the morning |
| A patient has a diagnosis of rheumatoid arthritis and the primary care provider has now prescribed cyclophosphamide (Cytoxan). The nurses subsequent assessments should address what potential adverse effect? | Infection and bone marrow suppression |
| A nurse is assessing a patient for risk factors known to contribute to osteoarthritis. What assessment finding would the nurse interpret as a risk factor? | The patients body mass index is 34 (obese). |
| A patient is undergoing diagnostic testing to determine the etiology of recent joint pain. The patient asks the nurse about the difference between osteoarthritis (OA) and rheumatoid arthritis (RA). What is the best response by the nurse? | OA is a considered a noninflammatory joint disease. RA is characterized by inflamed, swollen joints. |
| degenerative arthritis with a noninflammatory etiology, characterized by the loss of cartilage on the articular surfaces of weight-bearing joints, with spur development. | OA |
| characterized by inflammation of synovial membranes and surrounding structures. | RA |
| A patient with systemic lupus erythematosus (SLE) is preparing for discharge. The nurse knows that the patient has understood health education when the patient makes what statement? | Ill make sure to monitor my body temperature on a regular basis. |
| The nurse is preparing to care for a patient who has scleroderma. The nurse refers to resources that describe CREST syndrome. Which of the following is a component of CREST syndrome? | Raynaud's phenomenon |
| Allopurinol (Zyloprim) has been ordered for a patient receiving treatment for gout. The nurse caring for this patient knows to assess the patient for bone marrow suppression, which may be manifested by which of the following diagnostic findings? | Decreased platelets |
| A patient with rheumatic disease is complaining of stomatitis. The nurse caring for the patient should further assess the patient for the adverse effects of what medications? | gold containing compounds |
| A nurse is working with a patient with rheumatic disease who is being treated with salicylate therapy. What statement would indicate that the patient is experiencing adverse effects of this drug? | I have this ringing in my ears that just wont go away. |
| A patient has been admitted to a medical unit with a diagnosis of polymyalgia rheumatica (PMR). The nurse should be aware of what aspects of PMR? Select all that apply | PMR has an association with the genetic marker HLA-DR4 Immunoglobulin deposits occur in PMR PMR occurs predominately in Caucasians |
| A nurse is providing care for a patient who has a recent diagnosis of giant cell arteritis (GCA). What aspect of physical assessment should the nurse prioritize? | Assessment for headaches and jaw pain |
| the nurse is educating a patient with gout about lifestyle modifications that can help control the signs and symptoms of the disease. What recommendation should the nurse make? | Limiting intake of alcohol |
| A patients rheumatoid arthritis (RA) has failed to respond appreciably to first-line treatments and the primary care provider has added prednisone to the patients drug regimen. What principle will guide this aspect of the patients treatment? | The drug should be used for as short a time as possible |
| A nurse is caring for a patient who is suspected of having giant cell arteritis (GCA). What laboratory tests are most useful in diagnosing this rheumatic disorder? Select all that apply. | Erythrocyte sedimentation rate, D-dimer |
| A community health nurse is performing a visit to the home of a patient who has a history of rheumatoid arthritis (RA). On what aspect of the patients health should the nurse focus most closely during the visit? | the patient functional status |
| A 21-year-old male has just been diagnosed with a spondyloarthropathy. What will be a priority nursing intervention for this patient? | Teaching about symptom management |
| The nurse is performing discharge teaching for a client with rheumatoid arthritis. What teachings are priorities for the client? Select all that apply. | Safe exercise, Assistive devices, Medication dosages and side effects |
| Which joint is most commonly affected in gout? | Metatarsophalangeal |
| The nurse is caring for a client who has been diagnosed with a "rheumatic disease." What nursing diagnoses will most likely apply to this client's care? Select all that apply. | Fatigue, Pain, Alteration of self-concept |
| The result of which diagnostic study is decreased in the client diagnosed with rheumatoid arthritis? | have a decreased red blood cell count |
| Increased creatinine may indicate | renal damage in SLE, scleroderma, and polyarteritis |
| Which term indicates an accumulation of crystalline depositions in articular surfaces, bones, soft tissue, and cartilage? | Tophi |
| Joint effusion refers to | the escape of fluid from the blood vessels or lymphatic vessels into the joint cavity. |
| Which term refers to fixation or immobility of a joint? | Ankylosis is the fixation or immobility of a joint. It may result from a disease process or from scarring due to trauma. |
| Which disorder is characterized by a butterfly-shaped rash across the bridge of the nose and cheeks? | Systemic lupus erythematous (SLE) |
| Fibromyalgia is a common condition that involves | chronic fatigue, generalized muscle aching, and stiffness. |
| What is the priority intervention for a client who has been admitted repeatedly with attacks of gout? | Assess diet and activity at home |
| Which points should be included in the medication teaching plan for a client taking adalimumab? | It is important to monitor for injection site reactions. |
| The nurse intervenes to assist the client with fibromyalgia to cope with which symptoms? | Chronic fatigue, generalized muscle aching, and stiffness |
| 12Which is an appropriate nursing intervention in the care of the client with osteoarthritis? | Encourage weight loss and an increase in aerobic activity |
| Which is the leading cause of disability and pain in the elderly? | Osteoarthritis (OA) |
| The nurse is teaching a client about rheumatic disease. What statement best helps to explain autoimmunity? | Your symptoms are a result of your body attacking itself." |
| The nurse teaches the client that the presence of crystals in the synovial fluid obtained from arthrocentesis confirms which disease process? | Gout |
| the presence of bacteria is indicative of | infective arthritis. |
| Osteoarthritis is known as a disease that | Is the most common and frequently disabling of joint disorders |
| Ankylosing spondylitis affects the | cartilaginous joints of the spine and surrounding tissues, making them rigid and decreasing mobility; it is usually diagnosed in the second or third decade of life. |
| The nurse is caring for a client who is being treated for fibromyalgia. What intervention will best assist the client to restore normal sleep patterns? | Tricyclic antidepressants |
| The side effect of bone marrow depression may occur with which medication used to treat gout? | Allopurinol |
| Which finding is consistent with the diagnosis of rheumatoid arthritis? | Cloudy synovial fluid |
| A client is admitted with an acute attack of gout. What interventions are essential for this client? Select all that apply. | Probenecid, Pain medication, Serum uric acid concentration, Corticosteroid therapy, Dietary consult |
| Which connective tissue disorder is characterized by insoluble collagen being formed and accumulating excessively in the tissues? | Scleroderma. occurs initially in the skin but also occurs in blood vessels, major organs, and body systems, potentially resulting in death |
| A client with rheumatoid arthritis reports joint pain. What intervention is a priority to assist the client? | Nonsteroidal anti-inflammatory drugs |
| Nursing care for the client with fibromyalgia should be guided by the assumption that patients with fibromyalgia | may feel as if their symptoms are not taken seriously |
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shanise909