exam 3
A 69-year-old client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct? a. OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints. b. OA and RA are very similar. OA affects the smaller joints and RA affects the larger, weight-bearing joints. c. OA affects joints on both sides of the body. RA is usually unilateral. d. OA is more common in women. RA is more common in men.
A
A patient presents at the walk-in clinic complaining of diarrhea and vomiting. The patient has a documented history of adrenal insufficiency. Considering the patient's history and current symptoms, the nurse should anticipate that the patient will be instructed to do which of the following? A) Increase his intake of sodium until the GI symptoms improve. B) Increase his intake of potassium until the GI symptoms improve. C) Increase his intake of glucose until the GI symptoms improve. D) Increase his intake of calcium until the GI symptoms improve.
A
A client with type 1 diabetes has been on a regimen of multiple daily injection therapy. The client is being converted to continuous subcutaneous insulin therapy. While teaching continuous subcutaneous insulin therapy, the nurse should tell the client that the regimen includes the use of: 1. short- and long-acting insulins. 2. intermediate- and long-acting insulins. 3. rapid-acting insulin only. 4. short- and intermediate-acting insulins.
3
Which condition may contribute to hyperparathyroidism? A) Renal failure. B) Thyroidectomy C) Decreased serum calcium level D) Steroid use
A
Which of the following are usually the first choice in the treatment of rheumatoid arthritis (RA)? a. Disease-modifying antirheumatic drugs (DMARDs) b. NSAIDs c. TNF blockers Oral glucocorticoids d.
A
Adalimumab
Adalimumab injection is in a class of medications called tumor necrosis factor (TNF) inhibitors. It works by blocking the action of TNF, a substance in the body that causes inflammation. Immunosuppressive drug. It can treat RA. arthritis, plaque psoriasis, ankylosing spondylitis, Crohn's disease, and ulcerative colitis.
After cancer chemotherapy, a client experiences nausea and vomiting. The nurse should assign highest priority to which intervention?
Administering metoclopramide and dexamethasone as ordered
A client has received several treatments of bleomycin. It is now important for the nurse to assess a) Urine output b) Lung sounds c) Skin integrity d) Hand grasp
B
A patient has just been diagnosed with type 2 diabetes. The physician has prescribed an oral antidiabetic agent that will inhibit the production of glucose by the liver and thereby aid in the control of blood glucose. What type of oral antidiabetic agent did the physician prescribe for this patient? A)A sulfonylurea B)A biguanide C)A thiazolidinedione D)An alpha glucosidase inhibitor
B
A patient with a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH) is being cared for on the critical care unit. The priority nursing diagnosis for a patient with this condition is what? A) Risk for peripheral neurovascular dysfunction B) Excess fluid volume C) Hypothermia D) Ineffective airway clearance
B
A client has been admitted to the postsurgical unit following a thyroidectomy. To promote comfort and safety, how should the nurse best position the client? A. Side-lying with one pillow under the head B. Head of the bed elevated 30 degrees and no pillows placed under the head C. Semi-Fowler with the head supported on two pillows D. Supine, with a small roll supporting the neck
C
A client with diabetic ketoacidosis was admitted to the intensive care unit 4 hours ago and has these laboratory results: blood glucose level 450 mg/dl, serum potassium level 2.5 mEq/L, serum sodium level 140 mEq/L, and urine specific gravity 1.025. The client has two IV lines in place with normal saline solution infusing through both. Over the past 4 hours, his total urine output has been 50 ml. Which physician order should the nurse question? a. Infuse 500 ml of normal saline solution over 1 hour. b. Add 40 mEq potassium chloride to an infusion of half normal saline solution and infuse at a rate of 10 mEq/hour. c. Change the second IV solution to dextrose 5% in water. d. Hold insulin infusion for 30 minutes.
C
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
A client undergoes a biopsy of a suspicious lesion. The biopsy report classifies the lesion according to the TNM staging system as follows: TIS, N0, M0. What does this classification mean?
Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis
A nurse is performing a physical examination on client suspected of having an endocrine disorder. Which assessment finding might be indicative of a problem with the thyroid gland?
Cold intolerance
A client is recovering from an attack of gout. What will the nurse include in the client teaching? A. Weight loss will reduce purine levels. B. Weight loss will reduce inflammation. C. Weight loss will increase uric acid levels and reduce stress on joints. D. Weight loss will reduce uric acid levels and reduce stress on joints.
D
A female client is receiving methotrexate (Mexate), 12 g/m2 I.V., to treat osteogenic carcinoma. During methotrexate therapy, the nurse expects the client to receive which other drug to protect normal cells? a. probenecid (Benemid) b. cytarabine (ara-C, cytosine arabinoside [Cytosar-U]) c. thioguanine (6-thioguanine, 6-TG) d. leucovorin (citrovorum factor or folinic acid [Wellcovorin])
D
Etanercept (ETN) ENBREL
Etanercept (ETN) ENBREL is a medicine that affects your immune system. It is the first anti-tumor necrosis factor (TNF) agent to be approved for the treatment of rheumatoid arthritis (RA).
A client with chronic renal failure complains of generalized bone pain and tenderness. Which assessment finding would alert the nurse to an increased potential for the development of spontaneous bone fractures?
Hyperphosphatemia
methotrexate
Methotrexate is one of the most effective medications to treat rheumatoid arthritis (RA) Methotrexate is administered once or twice per week. The nurse should ask the client to teach back to the nurse to ensure the client understands the dosing schedule. RA may be treated with a nonbiologic or biologic disease-modifying antirheumatic drug (DMARD). Methotrexate is a nonbiologic DMARD that produces immune suppression and reduces inflammation. Because this drug can cause birth defects or miscarriages, a pregnancy test should be obtained before starting methotrexate.
Which assessment findings would the nurse expect in the client with osteomalacia?
Osteomalacia is characterized by decreased serum calcium and phosphorus and elevated alkaline phosphatase levels.
A bowel resection is scheduled for a client with the diagnosis of colon cancer with metastasis to the liver and bone. Which statement by the nurse best explains the purpose of the surgery?
"Tumor removal will promote comfort."
The nurse practitioner assesses a client in the physician's office. Which assessment findings support a suspicion of systemic lupus erythematosus (SLE)? 1. Facial erythema, profuse proteinuria, pleuritis, fever, and weight loss 2. Pericarditis, photosensitivity, polyarthralgia, and painful mucous membrane ulcers 3. Weight gain, hypervigilance, hypothermia, and edema of the legs 4. Hypothermia, weight gain, lethargy, and edema of the arms
1
Hydroxychloroquine
Hydroxychloroquine is a disease-modifying anti-rheumatic drug (DMARD). It regulates the activity of the immune system, which may be overactive in some conditions. Hydroxychloroquine can modify the underlying disease process, rather than simply treating the symptoms. Like with many other DMARDs, you will not feel the effects of HCQ right away. Most people start noticing the effects about six to eight weeks after they start to take the medication, but full benefit may not be apparent for up to three months. It is important to be patient and continue taking your medication.
When reviewing laboratory results for a patient with a possible diagnosis of hypoparathyroidism, the nurse knows that this condition is characterized by which of the following?
Inadequate secretion of parathormone
Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"?
Test your blood glucose every 4 hours."
the side effect of bone marrow depression may occur with which medication used to treat gout?
allopurinol
A nurse is assessing a client with a terminal illness and finds that the client has cachexia. The nurse interprets this as indicating which of the following? A. Extreme anorexia B. Severe asthenia C. Starvation D. Profound protein loss
D
Which statement about fluid replacement is accurate for a client with hyperosmolar hyperglycemic nonketotic syndrome (HHNS)? 1. Administer 2 to 3 L of I.V. fluid over 2 to 3 hours. 2. Administer 6 L of I.V. fluid over the first 24 hours. 3. Administer a dextrose solution containing normal saline solution. 4. Administer I.V. fluid slowly to prevent circulatory overload and collapse.
1
The physician orders tests to determine if a client has systemic lupus erythematosus (SLE). Which test result confirms an SLE diagnosis? 1. Increased total serum complement levels 2. Negative antinuclear antibody test 3. Negative lupus erythematosus cell test 4. An above-normal anti-deoxyribonucleic acid (DNA) test
4
A nurse should expect to administer which medication to a client with gout? a. Colchicine b. Aspirin c. Furosemide d. Calcium gluconate
A
A nurse who works in an oncology clinic is assessing a patient who has arrived for a 2-month follow-up appointment following chemotherapy. The nurse notes that the patient's skin appears yellow. Which blood tests should be done to further explore this clinical sign? A) Liver function tests (LFTs) B) Complete blood count (CBC) C) Platelet count D) Blood urea nitrogen and creatinine
A
A patient has a diagnosis of rheumatoid arthritis and the primary care provider has now prescribed cyclophosphamide (Cytoxan). The nurse's subsequent assessments should address what potential adverse effect? A) Infection B) Acute confusion C) Sedation D) Malignant hyperthermia
A
On assessment of a patient with early-stage hypothyroidism, the nurse practitioner assesses for a vague yet significant sign which is: A. Paresthesia B. Hypotension C. Bradypnea D. Hypothermia
A
The client is receiving a vesicant antineoplastic for treatment of cancer. Which assessment finding would require the nurse to take immediate action? a. Extravasation b. Stomatitis c. Nausea and vomiting d. Bone pain
A
The nurse is reviewing the diagnostic test findings of a client with rheumatoid arthritis. Which of the following would the nurse expect to find? a) Elevated erythrocyte sedimentation rate b) Increased albumin levels c) Increased red blood cell count d) Increased C4 complement
A
The nursing educator is talking with a group of recent nursing graduates about common diagnoses on the unit. What diffuse connective tissue disease would the instructor tell the group is caused by an autoimmune reaction that results in phagocytosis, producing enzymes within the joint that break down collagen and cause edema? A. Rheumatoid arthritis (RA) B. Systemic lupus erythematosus (SLE) C. Osteoporosis D. Polymyositis
A
terminal illness. Which assessment findings indicate to the nurse that the client will die within a few hours? Select all that apply. a. Irregular pulse b. Apnea lasting 45 seconds c. Mottled extremities d. Verbalizing incoherent phrases e. Systolic blood pressure of 80 mm Hg with no diastolic reading
A B C
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 B D
The nurse is describing some of the major characteristics of cancer to a patient who has recently received a diagnosis of malignant melanoma. When differentiating between benign and malignant cancer cells, the nurse should explain differences in which of the following aspects? Select all that apply. A) Rate of growth B) Ability to cause death C) Size of cells D) Cell contents E) Ability to spread
A B E
Chemotherapeutic agents have different specific classifications. The following medications are antineoplastic antibiotics except: a. Doxorubicin (adriamycin) b. fluorouracil (adrucil) c. bleomycin (blenoxane) d. Mitoxantrone (Novantrone)
B
The nurse is caring for a patient with Addisons disease who is scheduled for discharge. When teaching the patient about hormone replacement therapy, the nurse should address what topic? A) The possibility of precipitous weight gain B) The need for lifelong steroid replacement C) The need to match the daily steroid dose to immediate symptoms D) The importance of monitoring liver function
B
A male client is receiving the cell cycle-nonspecific alkylating agent thiotepa (Thioplex), 60 mg weekly for 4 weeks by bladder instillation as part of a chemotherapeutic regimen to treat bladder cancer. The client asks the nurse how the drug works. How does thiotepa exert its therapeutic effects? a. It interferes with deoxyribonucleic acid (DNA) replication only. b. It interferes with ribonucleic acid (RNA) transcription only. c. It interferes with DNA replication and RNA transcription. d. It destroys the cell membrane, causing lysis.
C
A nurse is performing the health history and physical assessment of a client who has a diagnosis of rheumatoid arthritis (RA). What assessment finding is most consistent with the clinical presentation of RA? A. Cool joints with decreased range of motion B. Signs of systemic infection C. Joint stiffness lasting longer than 1 hour, especially in the morning D. Visible atrophy of the knee and shoulder joints
C
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. "There are no activity limitations between flare-ups." c. "Monitor your body temperature." d. "Corticosteroids may be stopped when symptoms are relieved."
C
A patient has returned to the floor after having a thyroidectomy for thyroid cancer. The nurse knows that sometimes during thyroid surgery the parathyroid glands can be injured or removed. What laboratory finding may be an early indication of parathyroid gland injury or removal? A. Hyponatremia B. Hypophasphatemia C. Hypocalcemia D. Hypokalemia
C
The nurse caring for a patient with Cushing syndrome is describing the dexamethasone suppression test scheduled for tomorrow. What does the nurse explain that this test will involve? A) Administration of dexamethasone orally, followed by a plasma cortisol level every hour for 3 hours B) Administration of dexamethasone IV, followed by an x-ray of the adrenal glands C) Administration of dexamethasone orally at 11 PM, and a plasma cortisol level at 8 AM the next morning D) Administration of dexamethasone intravenously, followed by a plasma cortisol level 3 hours after the drug is administered
C
A nurse is providing a class on osteoporosis at the local seniors' center. Which of the following statements related to osteoporosis is most accurate? A) Osteoporosis is categorized as a disease of the elderly. B) A nonmodifiable risk factor for osteoporosis is a person's level of activity. C) Secondary osteoporosis occurs in women after menopause. D) Slow discontinuation of corticosteroid therapy can halt the progression of the osteoporosis.
D
A nurse is reviewing the care of a patient who has a long history of lower back pain that has not responded to conservative treatment measures. The nurse should anticipate the administration of what drug? A) Calcitonin B) Prednisone C) Aspirin D) Cyclobenzaprine
D
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? A)Hyperuricemia B)Increased erythrocyte sedimentation rate C)Elevated serum creatinine D)Decreased platelets
D
The nurse knows that interferon agents are used in association with chemotherapy to produce which effects in the client? A) Suppression of the bone marrow B) Enhance action of the chemotherapy C) Decrease the need for additional adjuvant therapies D) Shorten the period of neutropenia
D
A hospitalized client with terminal heart failure is nearing the end of life. The nurse observes which of the following breathing patterns?
cheyne strokes
