Med Surg PrepU Exam 1
A client suspected of having systemic lupus erythematosus (SLE) is being scheduled for testing. The client asks which of the tests ordered will determine positivity for the disorder. Which statement by the nurse is most accurate? "You should discuss that matter with your health care provider." "Tell me more about your concerns about this potential diagnosis." "SLE is a very serious systemic disorder." "The diagnosis won't be based on the findings of a single test but by combining all data found."
"The diagnosis won't be based on the findings of a single test but by combining all data found."
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." "You have inherited your parent's immunity to the disease." "You have antigens to the disease, but they do not prevent the disease." "You are not immune to the disease causing the symptoms."
"Your symptoms are a result of your body attacking itself."
Which body substance causes increased gastric secretion, dilation of capillaries, and constriction of the bronchial smooth muscle? 1- Histamine 2- Bradykinin 3- Serotonin 4- Prostaglandin
1- Histamine
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 1- urticaria. 2- contact dermatitis. 3- pitting edema. 4- angioneurotic edema
4- angioneurotic edema
What is a common second-generation nonsedating antihistamine used to treat allergies? A) Cetirizine (Zyrtec) B) Chlorpheniramine (Chlor-Trimeton) C) Diphenhydramine (Benadryl) D) Hydroxyzine (Atarax)
A) Cetirizine (Zyrtec)
The nurse is teaching a client after a medication allergic reaction has occurred. What is the most important action for the nurse to teach the client to take to prevent anaphylaxis? Avoid potential allergens. Carry an emergency kit. Undergo desensitization treatment. Wear a medical alert bracelet.
Avoid potential allergens.
What teaching point should the nurse prioritize when providing health education to the family of a child with a newly diagnosed food allergy? A) Managing the GI symptoms of a food allergy B) Strategies for avoiding the offending food C) Techniques for ensuring adequate nutrition
B. Strategies for avoiding the offending food
The nurse explains to a client that immunotherapy initially starts with injections at which interval? Monthly Bi-monthly Daily Weekly
Bi-monthly
The nurse is caring for a client with polymyositis. Which type of medication will the nurse explain to this client? Anticoagulants Antibiotics Nonsteroidal anti-inflammatory drugs Corticosteroids
Corticosteroids The goal is to control inflammation and prevent long-term damage to muscles, joints, and internal organs. Corticosteroid therapy is the mainstay of medical management of the client with polymyositis.
A client with lupus has had antineoplastic drugs prescribed. Why would the physician prescribe antineoplastic drugs for an autoimmune disorder? So the client has strong drug therapy Because an autoimmune disease is a neoplastic disease To decrease the body's risk of infection For their immunosuppressant effects
For their immunosuppressant effects
Which is the leading cause of disability and pain in the elderly? Osteoarthritis (OA) Systemic lupus erythematosus (SLE) Rheumatoid arthritis (RA) Scleroderma
Osteoarthritis (OA)
Which intervention is the single most important aspect for the client at risk for anaphylaxis? 1- Use of antihistamines 2- Desensitization 3- Wearing a medical alert bracelet 4- Prevention
Prevention
A client with systemic lupus erythematosus is prescribed belimumab. For which reason will the nurse question giving the client this medication? Received a live vaccination a week ago Discoid rash present over the face Report of constipation Bilateral knee joint swelling is present
Received a live vaccination a week ago
Which term indicates an accumulation of crystalline depositions in articular surfaces, bones, soft tissue, and cartilage? Subchondral bone Pannus Joint effusion Tophi
Tophi
A nurse is preparing a discharge teaching plan for a client with atopic dermatitis. Which instruction should the nurse include in the teaching plan? 1- Wear only synthetic fabrics. 2- Use a topical skin moisturizer daily. 3- Bathe only three times per week. 4- Keep the thermostat above 75° F (23.9° C).
Use a topical skin moisturizer daily.
Fibromyalgia is a common condition that involves pain, viral infection, and tremors. generalized muscle aching, mood swings, and loss of balance. chronic fatigue, generalized muscle aching, and stiffness. diminished vision, chronic fatigue, and reduced appetite.
chronic fatigue, generalized muscle aching, and stiffness.
The nurse is administering intravenous vancomycin. What will the nurse initially assess the client for if an allergic reaction occurs? the presence and location of pruritus the severity of cutaneous warmth and flushing hypotension and tachycardia dyspnea, bronchospasm, and/or laryngeal edema
dyspnea, bronchospasm, and/or laryngeal edema
The nurse is gathering a health history for a client with osteoarthritis. What clinical manifestation will the nurse expect to find? small joint involvement subcutaneous nodules joint pain that increases with rest early morning stiffness
early morning stiffness
A client is being treated for hyperuricemia. Part of the treatment strategy is for the client to avoid contributing factors whenever possible. Which activities might bring on an acute attack? frequently drinking coffee eating organ meats and sardines frequently ingesting salicylates high carbohydrate intake
eating organ meats and sardines
Nursing care for the client with fibromyalgia should be guided by the assumption that patients with fibromyalgia will eventually lose their ability to walk. may feel as if their symptoms are not taken seriously. rarely respond to treatment. all have the same type of symptoms.
may feel as if their symptoms are not taken seriously.
The nurse is teaching a client about histamine release during an anaphylactic reaction. What does histamine release in anaphylaxis cause? nasal congestion feeling of impending doom urinary urgency stomach cramps
nasal congestion
A diet plan is developed for a client with gouty arthritis. What should the nurse advise the client to limit the intake of? green vegetables fresh fish citrus fruits organ meats
organ meats
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. They occur within minutes after exposure to latex. They may worsen when hand lotion is applied before donning latex gloves. They can be eliminated by changing glove brands or using powder-free gloves.
they are localized to the area of exposure, usually the back of the hands.
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 type III type II type IV
type I
A patient has been diagnosed with an allergy to peanuts. What is a priority for this patient to carry at all times? 1- A medical alert bracelet 2- An H1 blocker 3- An EpiPen 4- An oral airway
3- An EpiPen
When could a "rebound" anaphylactic reaction occur after an initial attack even when epinephrine has been given? A) One hour B) Two hours C) Three hours D) Four hours
D) Four hours A "rebound" anaphylactic reaction can occur four to ten hours after an initial attack even when epinephrine has been given.
A client has had several recent clinical visits for allergic contact dermatitis. The nurse explains to the client that allergy testing is indicated. Which test will most likely be performed? All options are correct. patch test intradermal injection test scratch test
The patch test is used to identify the offending substance in allergic contact dermatitis.
Which of the following is the most common joint affected in gout? a) Tarsal area b) Metatarsophalangeal c) Knee d) Ankle
b) Metatarsophalangeal
Which of the following would a nurse encourage a client with gout to limit? a) Carbohydrates b) Purine-rich foods c) Fluid intake d) Protein-rich foods
b) Purine-rich foods
The nurse knows that a patient who presents with the symptom of "blanching of fingers on exposure to cold" would be assessed for what rheumatic disease? a) Reiter's syndrome b) Ankylosing spondylitis c) Sjögren's syndrome d) Raynaud's phenomenon
d) Raynaud's phenomenon
The nurse is reviewing various medications with a client that can be used to treat allergic disorders. What medication will the nurse identify as an intranasal corticosteroid? fluticasone zileuton cromolyn sodium fexofenadine
fluticasone
A client with a discoid facial rash caused by systemic lupus erythematosus (SLE) asks why a urine sample is needed. Which response will the nurse make to the client? "It is a routine test done on everyone." "The medication you take can affect your bladder." "The lupus can affect your kidney function." "The test will determine how long you will have the rash."
"The lupus can affect your kidney function."
A patient with seasonal allergies has told the nurse that a colleague recommended pseudoephedrine hydrochloride (Sudafed) as a means of controlling signs and symptoms. The nurse should be aware that this drug provides relief for many patients but adverse effects include a risk of: 1- Anxiety 2- Decreased urine output 3- Depression 4- Gastritis
1- Anxiety
The nurse is preparing to administer a medication that has an affinity for H1 receptors. Which medication would the nurse administer? 1- Diphenhydramine 2- Omeprazole 3- Cimetidine 4- Ranitidine
1- Diphenhydramine
A client is prescribed an oral corticosteroid for 2 weeks to relieve asthma symptoms. The nurse educates the client about side effects, which include 1- adrenal suppression. 2- diuresis. 3- hypoglycemia. 4- hypotension.
1- adrenal suppression.
A patient comes to the clinic with pruritus and nasal congestion after eating shrimp for lunch. The nurse is aware that the patient may be having an anaphylactic reaction to the shrimp. These symptoms typically occur within how many hours after exposure? 1- 2 hours 2- 6 hours 3- 12 hours 4- 24 hours
2 hours
What is the priority intervention for a client who has been admitted repeatedly with attacks of gout? Assess diet and activity at home Increase fluids Insert a Foley catheter Place client on bed rest
Assess diet and activity at home
A client is experiencing painful joints and changes in the lungs, heart, and kidneys. For which condition will the nurse schedule this client for diagnostic tests? Metabolic disorders Heart disease Vascular diseases Autoimmune disorders
Autoimmune disorders
A client is taking ibuprofen for the treatment of osteoarthritis. What education will the nurse give the client about the medication? Inform the health care provider if there is ringing in the ears. Take the medication on an empty stomach in order to increase effectiveness. Take the medication with food to avoid stomach upset. Since the medication is able to be obtained over the counter, it has few side effects.
Take the medication with food to avoid stomach upset.
Which of the following would the nurse expect to assess as the most common finding associated with fibromyalgia? a) Widespread chronic pain b) Jaw locking c) Butterfly facial rash d) Heberden nodes
a) Widespread chronic pain
A physician orders corticosteroids for a child with systemic lupus erythematosus (SLE). The nurse knows that the purpose of corticosteroid therapy for this child is to a) combat inflammation. b) prevent platelet aggregation. c) promote diuresis. d) prevent infection.
a) combat inflammation. Explanation:Corticosteroids are used to combat inflammation in a child with SLE. To prevent infection, the physician would order antibiotics. Aspirin is used to prevent platelet aggregation. Diuretics, not corticosteroids, promote diuresis. pg.1071
A client is recovering from an attack of gout. Client teaching should include the need to lose weight because: a) weight loss will reduce uric acid levels and reduce stress on joints. b) weight loss will reduce purine levels. c) weight loss will increase uric acid levels and reduce stress on joints. d) weight loss will reduce inflammation.
a) weight loss will reduce uric acid levels and reduce stress on joints.
A nurse is preparing a client with systemic lupus erythematosus (SLE) for discharge. Which instruction should the nurse include in the teaching plan? a) "Exposure to sunlight will help control skin rashes." b) "Monitor your body temperature." c) "Corticosteroids may be stopped when symptoms are relieved." d) "There are no activity limitations between flare-ups."
b) "Monitor your body temperature." Explanation:The nurse should instruct the client to monitor body temperature. Fever can signal an exacerbation and should be reported to the physician.
Nursing assessment findings reveal joint swelling and tenderness of the great toe. The nurse suspects which of the following? a) Rheumatoid arthritis b) Ankylosing spondylitis c) Osteoarthritis d) Gout
d) Gout
Which of the following would the nurse most commonly assess in a client with ankylosing spondylitis? a) Patchy hair loss on the scalp b) Red, butterfly-shaped facial rash c) Increased urine output d) Low back pain
d) Low back pain
A patient has a serum study that is positive for the rheumatoid factor. What does the nurse understand is the significance of this test result? a) Specific for RA b) Diagnostic for Sjögren's syndrome c) Diagnostic for SLE d) Suggestive of RA
d) Suggestive of RA
A patient is suspected of having myositis. The nurse prepares the patient for what procedure that will confirm the diagnosis? Muscle biopsy Computed tomography (CT) Bone scan Magnetic resonance imaging (MRI)
A muscle biopsy may reveal inflammatory infiltrate in the tissue.
A patient was seen in the clinic for hypertension and received a prescription for a new antihypertensive medication. The patient arrived in the emergency department a few hours after taking the medication with severe angioedema. What medication prescribed may be responsible for the reaction? Angiotensin receptor blocker Angiotensin-converting enzyme (ACE) inhibitor Vasodilator Beta blocker
Angiotensin-converting enzyme (ACE) inhibitor
The nurse is caring for a client with ankylosing spondylitis (AS). Which medication will the nurse expect to be prescribed for this client? Oral corticosteroids Antibiotics Anticoagulants Nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs are the first-line therapy for treating all spondyloarthropathies
A client presents at the clinic with an allergic disorder. The client asks the nurse what an "allergic disorder" means. What would be the nurse's best response? 1- "It means you are very sensitive to something inside of yourself." 2- "It is a hyperimmune response to something in the environment that is usually harmless." 3- "It is a muted response to something in the environment." 4- "It is a harmless reaction to something in the environment."
"It is a hyperimmune response to something in the environment that is usually harmless."
The nurse is administering a sympathomimetic drug to a patient. What areas of concern does the nurse have when administering this drug? (Select all that apply.) 1- Causes bronchodilation 2- Constricts integumentary smooth muscle 3- Dilates the muscular vasculature 4- Causes bronchoconstriction 5- Causes laryngospasm
1- Causes bronchodilation 2- Constricts integumentary smooth muscle 3- Dilates the muscular vasculature
The nurse is planning the care of an 8-year-old boy who has been diagnosed with atopic dermatitis. In the boy's plan of nursing care, what nursing diagnosis should the nurse prioritize? 1- Acute pain related to atopic dermatitis 2- Risk for delayed development related to atopic dermatitis 3- Risk for impaired skin integrity related to atopic dermatitis 4- Chronic pain related to atopic dermatitis
3- Risk for impaired skin integrity related to atopic dermatitis
The nurse is conducting discharge teaching for a client who is being discharged from the emergency department after an anaphylactic reaction to peanuts. Which education should the nurse include in the teaching? Select all that apply. 1- Use of sedatives to treat reactions 2- Desensitization to allergen 3- Wearing a medical alert bracelet 4- Avoiding allergens
3- Wearing a medical alert bracelet 4- Avoiding allergens
A patient asks the nurse if it would be all right to take an over-the-counter antihistamine for the treatment of a rash. What should the nurse educate the patient is a major side effect of antihistamines? 1- Diarrhea 2- Anorexia 3- Palpitations 4- Sedation
4- Sedation
As part of the assessment process for a client suspected of having gout, the nurse evaluated the client's serum uric acid levels. Select the value that is considered above the saturation point for crystal formation. 6.8 mg/dL (0.40 mmol/L) 4.0 mg/dL (0.24 mmol/L) 3.2 mg/dL (0.19mmol/L) 5.4 mg/dL (0.32 mmol/L)
6.8 mg/dL (0.40 mmol/L)
A patient with severe environmental allergies is scheduled for the first in a planned series of immunotherapy injections. What should be included in teaching the patient about the injection? 1- The injection will cure the response to the allergen within 6 to 8 weeks. 2- The patient will remain in the clinic to be monitored for 30 minutes following the injection. 3- Therapeutic failure occurs if the symptoms to the allergen do not decrease after 3 months. 4- Injections are usually administered twice weekly.
The patient will remain in the clinic to be monitored for 30 minutes following the injection.
Is the following statement true or false? A nurse who has a latex allergy should be advised to avoid wearing gloves while providing care.
False Rationale: A latex allergy does not remove the nurse's obligation to abide by standard precautions. The nurse should wear nonlatex gloves.
The client with rheumatoid arthritis has a red blood cell count of 3.2 cells/cu mm. Which nursing diagnosis has the highest priority for the client? a) Self-care deficit: Bathing b) Ineffective airway clearance c) Fatigue d) Risk for infection
c) Fatigue Explanation:Low red blood cell count can be related to inadequate nutrition. Insufficient RBC levels compromise the oxygen-carrying capacity of the blood, which can lead to fatigue.
Which of the following are usually the first choice in the treatment of rheumatoid arthritis (RA)? a) Disease-modifying antirheumatic drugs (DMARDS) b) Glucocorticoids c) Nonsteroidal anti-inflammatory drugs (NSAIDs) d) Tumor necrosis factor (TNF) blockers
c) Nonsteroidal anti-inflammatory drugs (NSAIDs)
Which diagnostic study finding is decreased in patients diagnosed with rheumatoid arthritis? a) Uric acid b) Creatinine c) Red blood cell count d) Erythrocyte sedimentation rate (ESR)
c) Red blood cell count
After teaching a group of students about systemic lupus erythematosus, the instructor determines that the teaching was successful when the students state which of the following? a) The symptoms are primarily localized to the skin but may involve the joints. b) This disorder is more common in men in their thirties and forties than in women. c) The belief is that it is an autoimmune disorder with an unknown trigger. d) It has very specific manifestations that make diagnosis relatively easy.
c) The belief is that it is an autoimmune disorder with an unknown trigger.
A nurse is caring for a client with a warm and painful toe from gout. What medication will the nurse administer? calcium gluconate furosemide aspirin colchicine
colchicine to reduce urate crystal deposits and thus ease joint inflammation.
A client diagnosed with arthritis doesn't want to take medications. Physical therapy and occupational therapy have been consulted for nonpharmacologic measures to control pain. What might physical and occupational therapy include in the care plan to help control this client's pain? a) Acupuncture b) Cold therapy c) Heat therapy and nonsteroidal anti-inflammatory medications (NSAIDs) d) An exercise routine that includes range-of-motion (ROM) exercises
d) An exercise routine that includes range-of-motion (ROM) exercises
The nurse is educating a client about the risks of stroke related to the new prescription for a COX-2 inhibitor and what symptoms to report. Which COX-2 inhibitor is the nurse educating the client about? Tolmetin sodium Piroxicam Celecoxib Ibuprofen
Celecoxib The COX-2 inhibitor celecoxib (Celebrex) is associated with an increased risk of cardiovascular events, including myocardial infarction and stroke.
A patient has developed severe contact dermatitis with burning, itching, cracking, and peeling of the skin on her hands. What should the patient be instructed to do? 1- Wear powdered latex gloves. 2- Wash her hands with antibacterial soap. 3- Maintain the room temperature at 80°F. 4- Keep her hands well moisturized.
Keep her hands well moisturized.
A client comes to the clinic reporting nasal congestion and states, "I've been using an over-the-counter nasal spray that seemed to help at first, but then I got even more congested than before I started the medication. I continued the nasal spray, but it seems to be worse." What reaction will the nurse suspect? Rhinitis medicamentosa Development of a new allergy Tolerance to the medication Drug overdose
Rhinitis medicamentosa
The side effect of bone marrow depression may occur with which medication used to treat gout? a) Allopurinol (Zyloprim) b) Colchicine c) Prednisone d) Probenecid (Benemid)
a) Allopurinol (Zyloprim)
The nurse is caring for a patient who is being treated for fibromyalgia. What intervention will best assist the patient to restore normal sleep patterns? a) Administering opioids at bed time b) Tricyclic antidepressants c) Range-of-motion exercise prior to sleeping d) Increasing activity during the day
b) Tricyclic antidepressants Tricyclic antidepressants and sleep hygiene measures are used to improve or restore normal sleep patterns in patients with fibromyalgia. Increasing activity during the day or using range-of-motion exercises will not increase the patient's ability to sleep.
The nurse is performing a health history with a new client in the clinic. What is the most common reason for a client to seek medical attention for arthritis? stiffness pain joint swelling weakness
pain
The nurse is teaching a client with osteoarthritis about the disease. What is the most important client focus for disease management? detection of systemic complications prevention of joint deformity strategies for remaining active disease-modifying antirheumatic drug therapy
strategies for remaining active
An occupational health nurse is assessing a woman who experienced an anaphylactic reaction to a dip that contained crab during an office celebration. Because the woman promptly self-administered epinephrine, her status has normalized and she is now resting in a colleague's office. What action should the nurse perform? 1- Liaise with the woman's family and arrange for her to return home. 2- Have the woman transported to a nearby emergency department. 3- Encourage the woman to limit her physical activity for the next 24 to 48 hours. 4- Provide reassurance to limit the woman's anxiety.
2- Have the woman transported to a nearby emergency department.
A nurse is caring for a client with atopic dermatitis. Which suggestions for the client by the nurse would be appropriate? Select all that apply. 1 -Use a strong antibacterial detergent for the laundry. 2- Keep the room temperature at approximately 70 degrees Fahrenheit (21 degrees Celcius). 3- Apply topical moisturizers to the skin. 4- Wear clothing made from synthetic fabrics. 5- Humidify the home when the heat is on during the winter.
2- Keep the room temperature at approximately 70 degrees Fahrenheit (21 degrees Celcius). 3- Apply topical moisturizers to the skin. 5- Humidify the home when the heat is on during the winter.
A clinic nurse has been charged with the responsibility of teaching avoidance strategies to an adult patient who has allergic rhinitis. What measure should the nurse recommend to this patient? 1- "Make sure that there are never air drafts in your home." 2- "Avoid the use of air conditioning whenever possible." 3- "If possible, make sure that no one smokes tobacco in your home." 4- "Keep your windows open to ensure adequate air circulation."
3- "If possible, make sure that no one smokes tobacco in your home."
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? 1- Laryngeal edema 2- Rhinitis 3- Blistering 4- Angioedema
3- Blistering
A patient has been brought to the emergency department in apparent anaphylaxis. The priority aspect of care is: A) Ensuring a patent airway B) Managing the patient's anxiety C) Assessing the patient's circulatory status D )Preventing complications of anaphylaxis
A. Ensuring a patent airway
A nurse assesses a client in the health care provider's office. Which assessment findings support a suspicion of systemic lupus erythematosus (SLE)? Hypothermia, weight gain, lethargy, and edema of the arms Facial erythema, pericarditis, pleuritis, fever, and weight loss Photosensitivity, polyarthralgia, and painful mucous membrane ulcers Weight gain, hypervigilance, hypothermia, and edema of the legs
Facial erythema, pericarditis, pleuritis, fever, and weight loss
A patient is experiencing an allergic reaction to a dose of penicillin. What should the nurse look for in the patient's initial assessment? Hypotension and tachycardia Dyspnea, bronchospasm, and/or laryngeal edema. The presence and location of pruritus The severity of cutaneous warmth and flushing
Dyspnea, bronchospasm, and/or laryngeal edema.
A 10-year-old boy has been brought to the emergency department (ED) by ambulance in apparent anaphylaxis after accidentally eating a snack bar that contained peanuts. The ED nurse should be aware that this patient's signs and symptoms are attributable to: 1- Dissolution of the basement membranes of epithelium 2- Rapid activation of the clotting cascade 3- A massive release of histamine 4- Activation of the sympathetic nervous system (SNS)
3- A massive release of histamine
Which client is most likely to develop systemic lupus erythematosus (SLE)? a) A 27-year-old black female b) A 25-year-old white male c) A 35-year-old Hispanic male d) A 25-year-old Jewish female
a) A 27-year-old black female
A client is receiving treatment for an acute episode of gout with colchicine. The nurse is administering the medication every 2 hours. What should the nurse be sure the client communicates so that the drug can be temporarily stopped? Select all that apply. a) Nausea and vomiting b) Tingling in the arms c) Increase in pain in the affected extremity d) Intestinal crampinge) Diarrhea
e) Diarrhea d) Intestinal cramping a) Nausea and vomiting
A client is being discharged from the hospital after being diagnosed with and treated for systemic lupus erythematosus (SLE). What would the nurse not say when teaching the client and family information about managing the disease? Pace activities. If you have problems with a medication, you may stop it until your next physician visit. Avoid sunlight and ultraviolet radiation. Maintain a well-balanced diet and increase fluid intake to raise energy levels and promote tissue healing.
if you have problems with a medication, you may stop it until your next physician visit. Take medications exactly as directed and do not stop the medication if symptoms are relieved unless advised to do so by the physician. Sunlight tends to exacerbate the disease. Because fatigue is a major issue, allow for adequate rest, along with regular activity to promote mobility and prevent joint stiffness. Maintain a well-balanced diet and increase fluid intake to raise energy levels and promote tissue healing.
A nurse is reading a journal article about medications used to treat allergic rhinitis. The nurse demonstrates understanding of the information when identifying which medication as being the most effective maintenance therapy for chronic allergic rhinitis? 1- Second-generation antihistamines 2- Mast cell stabilizers 3- Adrenergic agents 4- Intranasal corticosteroids
4- Intranasal corticosteroids
The nurse is discussing the new medication that a client will be taking for treatment of rheumatoid arthritis. Which disease-modifying antirheumatic drug (DMARD) will the nurse educate the client about? Methotrexate Mercaptopurine azathioprine Celecoxib Methylprednisolone
Methotrexate is a DMARD that reduces the amount of joint damage and slows the damage to other tissues as well.
A nurse is teaching a client about rheumatoid arthritis. Which statement by the client indicates understanding of the disease process? a) "It will get better and worse again." b) "It will never get any better than it is right now." c) "When it clears up, it will never come back." d) "I'll definitely need surgery for this."
a) "It will get better and worse again."
Which of the following medications are used in the treatment of gout? Select all that apply. a) Probenecid (Benemid) b) Febuxostat (Uloric) c) Sulfasalazine (Azulfidine) d) Hydroxychloroquine (Plaquenil) e) Allopurinol (Zyloprim)
a) Probenecid (Benemid) e) Allopurinol (Zyloprim) b) Febuxostat (Uloric) Explanation:Benemid, Zyloprim, and Uloric are used in the treatment of gout. Plaquenil and Azulfidine are useful in the treatment of rheumatoid arthritis.
The nurse is performing discharge teaching for a patient with rheumatoid arthritis. What teachings are priorities for the patient? Select all that apply. a) Dressing changes b) Narcotic safety c) Safe exercise d) Medication dosages and side effects e) Assistive devices
c) Safe exercise d) Medication dosages and side effects e) Assistive devices
Ms. Dowe was seen in the clinic for musculoskeletal pain, fatigue, mood disorders, and sleep disturbances. The physician has diagnosed fibromyalgia. Which of the following would not be a part of teaching plan for her condition? a) Encouraging the client to eat a healthy diet b) Regular exercise and stress reduction c) Avoiding caffeine and alcohol d) Applications of ice
d) Applications of ice
A client with fibromyalgia asks why physical therapy has been prescribed. Which response will the nurse make? "It will help with the overall deconditioning that has occurred." "It will take your mind off your health problem." "It is used instead of prescribing medications for the condition." "I will ask the health care provider it if is necessary."
"It will help with the overall deconditioning that has occurred." Treatment of fibromyalgia consists of attention to the specific symptoms that the client is experiencing. An individualized program of exercise is used to decrease muscle weakness and discomfort and improve the general deconditioning that occurs in clients with the condition
A client is upset about being diagnosed with allergies to peanuts and milk and does not want to avoid eating these items. Which treatment approach is best used to achieve desensitization of these food allergies in the client? Use of an epinephrine pen Corticosteroids H1 blockers Oral immunotherapy
Oral immunotherapy
A client with gout has been advised to lose weight. The client informs the nurse of plans to go on a "guaranteed rapid weight loss" plan that involves fasting and heavy exercise. Which response would be most appropriate? "Make sure to eat some fat occasionally with all that exercise." "The fasting is okay, but make sure you drink fluids when exercising." "There might be some difficulties with your plan and fasting." "Try combining the fasting with moderate exercise."
"There might be some difficulties with your plan and fasting." Clients should avoid fasting, low-carbohydrate diets, and rapid weight loss because these measures increase the likelihood of ketone formation, which inhibits uric acid excretion. Gradual weight loss helps reduce serum uric acid levels in clients with gout.
The nurse teaches the patient that the presence of crystals in his or her synovial fluid obtained from an arthrocentesis confirms which disease process? a) Inflammation b) Degeneration c) Gout d) Infection
c) Gout
A client with osteoarthritis expresses concerns that the disease will prevent the ability to complete daily chores. Which suggestion should the nurse offer? "Do all your chores after performing morning exercises to loosen up." "Pace yourself and rest frequently, especially after activities." "Do all your chores in the morning, when pain and stiffness are least pronounced." "Do all your chores in the evening, when pain and stiffness are least pronounced."
Pace yourself and rest frequently, especially after activities.
Which of the following suggests to the nurse that the client with systemic lupus erythematous is having renal involvement? a) Hypertension b) Chest pain c) Behavioral changes d) Decreased cognitive ability
a) Hypertension
• ]The best treatment for latex allergy is 1- corticosteroids. 2- avoidance of latex-based products. 3- antihistamines. 4- epinephrine from an emergency kit.
2- avoidance of latex-based products.
The nurse is evaluating a client's complete blood cell count and differential along with the serum immunoglobulin E (IgE) concentration. Which result might indicate that the client has an allergic disorder? 1- High IgE concentration 2- High neutrophil count 3- Low eosinophil count 4- Low white blood cell count
1- High IgE concentration
A patient with severe environmental allergies is scheduled for the first in a planned series of immunotherapy injections. What should be included in teaching the patient about the injection? 1- The injection will cure the response to the allergen within 6 to 8 weeks. 2- The patient will remain in the clinic to be monitored for 30 minutes following the injection. 3- Therapeutic failure occurs if the symptoms to the allergen do not decrease after 3 months. 4- Injections are usually administered twice weekly.
2- The patient will remain in the clinic to be monitored for 30 minutes following the injection
A client develops contact dermatitis in response to adhesive tape used to secure a dressing. The nurse interprets this reaction as an example of which type of hypersensitivity? 1- Type I 2- Type II 3- Type III 4- Type IV
4- Type IV
A client is experiencing an acute exacerbation of rheumatoid arthritis. What should the nursing priority be? Providing comprehensive client teaching; including symptoms of the disorder, treatment options, and expected outcomes Performing meticulous skin care Administering ordered analgesics and monitoring their effects Supplying adaptive devices, such as a zipper-pull, easy-to-open beverage cartons, lightweight cups, and unpackaged silverware
Administering ordered analgesics and monitoring their effects
The nurse is reviewing the diagnostic test findings of a client with rheumatoid arthritis. What would the nurse expect to find? Increased C4 complement Increased albumin levels Increased red blood cell count Elevated erythrocyte sedimentation rate
Elevated erythrocyte sedimentation rate
Is the following statement True or False? An antigen is a protein substance developed by the body in response to and interacting with a specific antibody.
False An antibody, not antigen, is a protein substance developed by the body in response to and interacting with a specific antigen, not antibody.
Which body substance causes increased gastric secretion, dilation of capillaries, and constriction of the bronchial smooth muscle? Bradykinin Histamine Serotonin Prostaglandin
Histamine
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? Intravenous Intradermal Intramuscular Subcutaneous
Intradermal
Which points should be included in the medication teaching plan for a client taking adalimumab? The medication is given at room temperature. The client should continue taking the medication if fever occurs. It is important to monitor for injection site reactions. The medication is administered intramuscularly.
It is important to monitor for injection site reactions when taking adalimumab. The medication is injected subcutaneously and must be refrigerated. The medication should be withheld if fever occurs.
A client is prescribed montelukast as part of a treatment plan for an allergic disorder. The nurse understands that this drug belongs to which class? Corticosteroid Nonsedating antihistamine Leukotriene-receptor antagonist Mast cell stabilizer
Leukotriene-receptor antagonist
A client is diagnosed with systemic lupus erythematosus (SLE). Which of the following would be most appropriate for the nurse to use to evaluate the client' s stage of disease? Observe the client's gait. Review the client's medical record. Inspect the client's mouth. Auscultate the client's lung sounds.
Review the client's medical record.
A client with rheumatoid arthritis arrives at the clinic for a checkup. Which statement by the client refers to the most overt clinical manifestation of rheumatoid arthritis? a) "My finger joints are oddly shaped." b) "I have pain in my hands." c) "My legs feel weak." d) "I have trouble with my balance."
a) "My finger joints are oddly shaped." Joint abnormalities are the most obvious manifestations of rheumatoid arthritis.
A patient is seen in the office for complaints of joint pain, swelling, and a low-grade fever. What blood studies does the nurse know are consistent with a positive diagnosis of RA? (Select all that apply.) a) Positive antinuclear antibody (ANA) b) Positive C-reactive protein (CRP) c) Aspartate aminotransferase (AST) and alanine transaminase (ALT) levels of 7 units/L d) Red blood cell (RBC) count of <4.0 million/mcL e) Red blood cell (RBC) count of >4.0 million/mcL
a) Positive antinuclear antibody (ANA) b) Positive C-reactive protein (CRP) d) Red blood cell (RBC) count of <4.0 million/mcL
Osteoarthritis is known as a disease that requires early treatment because most of the damage seems to occur early in the course of the disease. affects young males. is the most common and frequently disabling of joint disorders. affects the cartilaginous joints of the spine and surrounding tissues.
is the most common and frequently disabling of joint disorders.
