NUR 130 Exam 4

A patient is prescribed a DMARD that is successful in the treatment of RA but has side effects, including retinal eye changes. What medication does the nurse anticipate educating the patient about?

Hydroxychloroquine (Plaquenil)

Which nursing diagnosis is least appropriate for the client with rheumatoid arthritis? Deficient knowledge: symptom management Impaired physical mobility Chronic pain Imbalanced nutrition: greater than body requirements

Imbalanced nutrition: greater than body requirements

A nurse is teaching a client about rheumatoid arthritis. Which statement by the client indicates understanding of the disease process?

"it will get better and worse again"

The goal for oxygen therapy in COPD is to support tissue oxygenation, decrease the work of the cardiopulmonary system, and maintain the resting partial arterial pressure of oxygen (PaO2) of at least ______ mm Hg and an arterial oxygen saturation (SaO2) of at least ___%. 58 mm Hg; 88% 60 mm Hg; 90% 54 mm Hg; 84% 56 mm Hg; 86%

60 mm Hg; 90%

Following are statements regarding medications taken by a patient diagnosed with COPD. Choose which statements correctly match the drug name to the drug category. Select all that apply.

> Albuterol is a bronchodilator > Ciprofloxacin is an antibiotic > Prednisone is a corticosteroid

A client is evaluated for severe pain in the right upper abdominal quadrant, which is accompanied by nausea and vomiting. The physician diagnoses acute cholecystitis and cholelithiasis. For this client, which nursing diagnosis takes top priority? Anxiety related to unknown outcome of hospitalization Acute pain related to biliary spasms Imbalanced nutrition: Less than body requirements related to biliary inflammation Deficient knowledge related to prevention of disease recurrence

Acute pain related to biliary spasms

A client is experiencing an acute exacerbation of rheumatoid arthritis. What should the nursing priority be?

Administering ordered analgesics and monitoring their effects

A client is diagnosed with a chronic respiratory disorder. After assessing the client's knowledge of the disorder, the nurse prepares a teaching plan. This teaching plan is most likely to include which nursing diagnosis? Anxiety Impaired swallowing Imbalanced nutrition: More than body requirements Unilateral neglect

Anxiety

The nurse is advising a client with multiple sclerosis on methods to minimize spasticity and contractures. Which of the following techniques would the nurse instruct the client to perform? Relax in a hot bath. Exercise following a circuit training regimen. Apply warm packs to the affected area. Avoid swimming and any weight-bearing activity.

Apply warm packs to the affected area.

Which intervention should be included in the plan of care for a client who has undergone a cholecystectomy? Clamping the T-tube immediately after surgery Assessing the color of the sclera every shift Placing the client on NPO (nothing by mouth) status for 2 days after surgery Placing the client in the semi-Fowler position immediately after surgery

Assessing the color of the sclera every shift

When providing discharge teaching for a client with multiple sclerosis (MS), the nurse should include which instruction? "Restrict fluid intake to 1,500 ml/day." "Avoid hot baths and showers." "Limit your fruit and vegetable intake." "Avoid taking daytime naps."

Avoid hot baths and showers

The diagnosis of pulmonary hypertension associated with chronic obstructive pulmonary disease (COPD) is suspected when which of the following is noted? Select all that apply. Left ventricular hypertrophy Dyspnea and fatigue disproportionate to pulmonary function abnormalities Enlargement of central pulmonary arteries Elevated plasma brain natriuretic peptide (BNP) Right ventricular enlargement

Dyspnea and fatigue disproportionate to pulmonary function abnormalities Right ventricular enlargement Elevated plasma brain natriuretic peptide (BNP) Enlargement of central pulmonary arteries

The nurse is reviewing the diagnostic test findings of a client with rheumatoid arthritis. Which of the following would the nurse expect to find?

Elevated erythrocyte sedimentation rate

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?

Fatigue

A nurse is preparing a client for surgery. During preoperative teaching, the client asks where is bile stored. The nurse knows that bile is stored in the: Cystic duct Duodenum Common bile duct Gallbladder

Gallbladder

In which grade of COPD is the forced expiratory volume (FEV) less than 30%?

IV

The client with rheumatoid arthritis is seen in the clinic. Which assessment finding indicates the client is having difficulty implementing self-care?

Increased fatigue

The diagnosis of multiple sclerosis is based on which test? Magnetic resonance imaging CSF electrophoresis Evoked potential studies Neuropsychological testing

Magnetic resonance imaging

Which of the following is considered a central nervous system (CNS) disorder? Myasthenia gravis Multiple sclerosis Bell's palsy Guillain-Barré

Multiple sclerosis

Which of the following are the most commonly reported clinical manifestations of MS? Select all that apply. Aphasia Numbness Fatigue Spasticity Depression Pain

Numbness, pain, spasticity, fatigue, depression

Which diagnostic study is decreased in patient diagnosed with rheumatoid arthritis?

RBC count

A nurse is caring for a male patient with COPD. While reviewing breathing exercises, the nurse instructs the patient to breathe in slowly through the nose, taking in a normal breath. Then, the nurse asks the patient to pucker his lips as if preparing to whistle. Finally, the patient is told to exhale slowly and gently through the puckered lips. The nurse teaches the patient this breathing exercise to accomplish which of the following? Select all that apply.

> Prevent collpase of the airways > Control the rate and depth of respirations >Release trapped air in the lungs

A client has been hospitalized for diagnostic testing. The client has just been diagnosed with multiple sclerosis, which the physician explains is an autoimmune disorder. How would the nurse explain an autoimmune disease to the client?

A disorder in which killer T cells and autoantibodies attack or destroy natural cells—those cells that are "self"

Which of the following are usually the first choice in the treatment of rheumatoid arthritis (RA)?

NSAIDS

A patient with rheumatoid arthritis is complaining of joint pain. What intervention is a priority to assist the patient?

NSAIDs

In chronic obstructive pulmonary disease (COPD), decreased carbon dioxide elimination results in increased carbon dioxide tension in arterial blood, leading to which of the following acid-base imbalances?

Respiratory acidosis

A patient is diagnosed with gallstones in the bile ducts. What laboratory results should the nurse review? Serum ammonia concentration of 90 mg/dL Serum albumin concentration of 4.0 g/dL Serum globulin concentration of 2.0 g/dL Serum bilirubin level greater than 1.0 mg/dL

Serum bilirubin level greater than 1.0 mg/dL

A patient comes to the clinic with fever, cough, and chest discomfort. The nurse auscultates crackles in the left lower base of the lung and suspects that the patient may have pneumonia. What does the nurse know is the most common organism that causes community-acquired pneumonia? Pseudomonas aeruginosa Mycobacterium tuberculosis Staphylococcus aureus Streptococcus pneumoniae

Streptococcus pneumoniae

A client with complaints of right lower quadrant pain is admitted to the emergency department. Blood specimens are drawn and sent to the laboratory. Which laboratory finding should be reported to the physician immediately?

White blood cell (WBC) count 22.8/mm3

The classification of Stage IV of COPD is defined as severe COPD. at risk for COPD. moderate COPD. mild COPD. very severe COPD.

very severe COPD

A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note:

yellow scelera

A client is admitted to a health care facility for treatment of chronic obstructive pulmonary disease. Which nursing diagnosis is most important for this client?

Impaired gas exchange related to airflow obstruction

The clinic nurse is caring for a client who has just been diagnosed with chronic obstructive pulmonary disease (COPD). The client asks the nurse what COPD means. What would be the nurse's best response?

"It means that the lungs have been damaged in such a way that there is limited airflow in and out of the lungs."

A client is newly diagnosed with relapsing-remitting multiple sclerosis (RRMS). Which instruction should the nurse provide? "You should take your medications only during times of relapse." "You will have a steady and gradual decline in function." "You must avoid stress and extreme fatigue, because these can trigger a relapse." "Your type of MS is the least common, making it difficult to manage."

"You must avoid stress and extreme fatigue, because these can trigger a relapse."

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 (Rheumatrex)

Which is a chronic, degenerative, progressive disease of the central nervous system characterized by the occurrence of demyelination in the brain and spinal cord? Parkinson disease Creutzfeldt-Jakob disease Huntington disease Multiple sclerosis

Multiple sclerosis

A client has been hospitalized for treatment of acute bacterial pneumonia. Which outcome indicates an improvement in the client's condition? The client exhibits restlessness and confusion. The client has a partial pressure of arterial carbon dioxide (PaCO2) value of 65 mm Hg or higher. The client exhibits bronchial breath sounds over the affected area. The client has a partial pressure of arterial oxygen (PaO2) value of 90 mm Hg or higher.

The client has a partial pressure of arterial oxygen (PaO2) value of 90 mm Hg or higher.

For a client with advanced chronic obstructive pulmonary disease (COPD), which nursing action best promotes adequate gas exchange?

Using a venturi mask to deliver oxygen as ordered

A nurse is caring for a client who is at high risk for developing pneumonia. Which intervention should the nurse include on the client's care plan? Using strict hand hygiene Keeping the head of the bed at 15 degrees or less Providing oral hygiene daily Turning the client every 4 hours to prevent fatigue

Using strict hand hygiene

Which of the following would not be considered a primary symptom of COPD?

Weight Gain

Upon assessment, the nurse suspects that a patient with COPD may have bronchospasm. What manifestations validate the nurse's concern? (Select all that apply.) Ascites Wheezes Decreased airflow Compromised gas exchange Jugular vein distention

Wheezes Decreased airflow Compromised gas exchange

A nurse is teaching a client with multiple sclerosis (MS). When teaching the client how to reduce fatigue, the nurse should tell the client to: rest in an air-conditioned room. increase the dose of muscle relaxants. avoid naps during the day. take a hot bath.

rest in an air-conditioned room.

A client with chronic obstructive pulmonary disease (COPD) reports increased shortness of breath and fatigue for 1 hour after awakening in the morning. Which of the following statements by the nurse would best help with the client's shortness of breath and fatigue?

"Delay self-care activities for 1 hour."

A nurse is caring for a client diagnosed with cholelithiasis. Which of the following would be most appropriate for a client who is experiencing biliary colic? Ensure that the client rests. Avoid administering antispasmodics. Administer analgesics to the client. Ensure that the client has eaten a full meal.

Administer analgesics to the client.

A 55-year-old client is scheduled for spirometry testing for evaluation of chronic obstructive pulmonary disease (COPD). The nurse Tells the client that arterial blood gas is performed after spirometry testing Explains to the client not to eat or drink before the spirometry test States that various blood tests must also be done Asks the client, "What are your allergies?"

Asks the client, "What are your allergies?"

A nurse is providing education to a client with newly diagnosed multiple sclerosis (MS). Which of the following will the nurse include?

Avoid hot temperatures.

Which term most precisely refers to the incision of the common bile duct for removal of stones? Choledochotomy Choledocholithotomy Choledochoduodenostomy Cholecystostomy

Choledocholithotomy

A client informs the nurse that he has been having abdominal pain that is relieved when having a bowel movement. The client states that the physician told him he has irritable bowel syndrome. What does the nurse recognize as characteristic of this disorder?

Chronic constipation with sporadic bouts of diarrhea

A 72-year-old patient who was admitted to the hospital for a total hip arthroplasty has developed increasing dyspnea and leukocytosis over the past 48 hours and has been diagnosed with hospital-acquired pneumonia (HAP). The choice of antibiotic therapy for this patient will be primarily based on which of the nurse's assessments?

Collection of a sputum sample for submission to the hospital laboratory

You are caring for a client who has been diagnosed with viral pneumonia. You are making a plan of care for this client. What nursing interventions would you put into the plan of care for a client with pneumonia? Give antibiotics as ordered. Offer nutritious snacks 2 times a day. Encourage increased fluid intake. Place client on bed rest.

Encourage increased fluid intake.

A nursing student understands the importance of the psychosocial aspects of disease processes. When working with a patient with COPD, the student would rank which of the following nursing diagnoses as the MOST important when analyzing the psychosocial effects? Activity intolerance related to fatigue Ineffective coping related to anxiety Disturbed sleep pattern related to cough High risk for ineffective therapeutic regimen management related to lack of knowledge

Ineffective coping related to anxiety

A nursing student is taking a pathophysiology examination. Which of the following factors would the student correctly identify as contributing to the underlying pathophysiology of chronic obstructive pulmonary disease (COPD)? Choose all that apply.

Inflamed airways that obstruct airflow Mucus secretions that block airways Overinflated alveoli that impair gas exchange

A patient is receiving gold sodium thiomalate (Myochrysine) for the treatment of RA. What does the nurse understand about the action of this compound?

Inhibits T and B cell acitivity

Which is the most prominent signs of inflammatory bowel disease?

Intermittent pain and diarrhea

A nursing student asks the instructor how to identify rheumatoid nodules in a client with rheumatoid arthritis. Which of the following characteristics would the instructor include?

Located over bony prominence

A client has an exacerbation of multiple sclerosis. The physician orders dantrolene (Dantrium), 25 mg P.O. daily. Which assessment finding indicates the medication is effective? Increased ability to sleep Relief from pain Relief from constipation Reduced muscle spasticity

Reduced muscle spasticity

A patient diagnosed with MS 2 years ago has been admitted to the hospital with another relapse. The previous relapse was followed by a complete recovery with the exception of occasional vertigo. What type of MS does the nurse recognize this patient most likely has? Primary progressive Benign Disabling Relapsing-remitting (RR)

Relapsing-remitting (RR)

The nurse is caring for a patient diagnosed with abdominal perforation. Which of the following is a clinical manifestation of this disease process? Bradycardia Normal erythrocyte sedimentation rate (ESR) Hypotension Subnormal temperature

hypotension