Q1 303/24
Gastroenteritis causes
bacteria virus (more common during the winter) parasitic emotional stress
an autoimmune disease characterized by damage to the small intestinal mucosa from ingesting wheat, barley, and rye. IT can occur at any age and has a wide variety of symptoms.
celiac disease
Irritable bowel syndrome
clinical syndrome of uncertain etiology characterized by lower abdominal pain and alternating diarrhea and constipation
Complications: more frequent include: strictures, fistulas, fissures; malabsorption & malnutrition Ulcerative colitis Crohns disease
crohns disease
Ulcers: the ulceration is deeper and may extend into all the layers of the bowel wall Ulcerative colitis Crohns disease
crohns disease
Immunosuppressants
depresses rheumatoid arthritis symptoms
Cause of IBS
emotional stress/ stress theory
NSAID/Glucocorticoids
helpful to treat pain and inflammation be cautious of BEERS
physical exam gastroenteritis
hyperactive bowel sounds abdominal distention fever tachycardia (shock) hypotension (shock) hypovolemia low fluids can lead to hypovolemic shock
What should you do if there is a small bowel obstruction?
insert a nasogastric tube and a peripheral IV
Diverticular disease
left lower quadrant in the sigmoid part of the colon due to high moving fecal content
gastroenteritis signs and symptoms
nausea/vomiting watery diarrhea anorexia abdominal cramping
New ileostomy
notify the physician immediately if there is no output for more than 12 hours
Treatment ASA Acetaminophen NSAIDs Treatment: hot and Cold, ROM, PT, exercise, weight management, bracing, joint replacement
osteoarthritis
Gastric ulcer
pain worsens with eating 55-65
Duodenal ulcer symptom
relief of pain with eating ages 30-55
Serotonin-norepinephrine re-uptake inhibitors
restores balance of neurotransmitters in patients with fibromyalgia
Management of Gastroenteritis
supportive care fluids for rehydration: clear liquids progressing anti-motility medications are not recommended for mild disease, contraindicated in patients with bloody stool or fever Travel's diarrhea prophylaxis: Bismuth subsalicylate (pepto bismol)
Appendicitis treatment
surgery and pain manangement
Bleeding common during Bowel movement Ulcerative colitis Crohns disease
ulcerative colitis
Complications-less common, partial bowel obstruction, pernicious anemia Ulcerative colitis Crohns disease
ulcerative colitis
Disease of non-smokers ulcerative colitis Crohns disease
ulcerative colitis
The mucous lining of the large intestine is ulcerated. these ulcers do not extend beyond this inner lining. Ulcerative colitis Crohns disease
ulcerative colitis
age and gender: adolescent to young adult F>M older adult M>F Ulcerative colitis Crohns disease
ulcerative colitis
Diagnostic of Peptic ulcer
-Endoscopy - H. pylori (gram negative bacteria) ingesting contaminated food/water -not genetic -Testing Helicobacter pylori causes chronic inflammation (infection) in the stomach and duodenum
Peptic ulcer disease causes
-H. Pylori (present > 90% of duodenal ulcer and >75% of gastric ulcers) erosion of the stomach lining or intestine (sometimes bleeds has H. pylori bacterium or is inflamed) -taking meds such as ASA, NSAID, glucocorticoids
A nurse is determining a clients risk of developing osteoporosis. The nurse should identify which of the following as risk factors for bone loss? SATA A. Small body frame B. Hypertension C. African-American ethnicity D. Low vitamin D intake E. Smoking
-Small body frame -Low vitamin D intake -Smoking Females have a higher risk of developing osteoporosis than males. Other risk factors include family history, low body mass index, and a small body frame. Consuming inadequate levels of calcium and vitamin D, Smoking, and ingesting high amounts of alcohol or caffeine also increase the risk of developing osteoporosis.
Bowel resection post op care
-auscultate abdomen to catch bowel obstruction -check temperature -watch for bleeding
Prevention of cancer
-avoid cigarettes and smokeless tobacco (chew0 -Inspect at dentist visits and wellness check-up -oral cancer can present with: red, velvety patches on the buccal mucosa
Skin breakdown prevention for patients with large abdominal surgeries Cachectic or severe edema
-provide pressure-relief mattress pt reposition every 2 hours to maintain skin integrity ROM q4 hours -Skinny patients are more at risk for coccyx ulcer or skin breakdown
Appendicitis labs
10,000-20,000 WBC CT or ultrasound diagnosis
Healing time
4-5 weeks
Antacids
Absorbs gastric acid Treatment of heartburn Calcium carbonate: Tums
Peptic ulcer treatment
Acid suppression- PPI before breakfast H2 blocker- cimetidine (at bedtime) H. Pylori eradication therapy: PPI, Metronidazole, clarithromycin
Osteoporosis meds:
Alendronate Raloxifene
Signs and symptoms of appendicitis
Begins with vague colicky umbilical pain: early after several hours pain shift to right lower quadrant: late Nausea with one to two episodes of vomiting (more vomiting suggest another diagnosis) Pain worsens with coughing
Management of constipation
Bulk forming laxative (with lots of fluids) Docusate sodium (Colace) stool softener -full glass of water -morning or bed time -with or without food -does not cause abdominal pain
Tube feeding
Check placement before feeding KUB Measurement and mark tube aspirate of stomach content Watch for change in breathing (tachypnea/ fast breathing) Auscultate lung sounds to ensure no aspiration/pneumonia occurs SPO2 desat If clogged: warm water irrigation- do not relocate tube notify provider-may order enzymes to unclog
A nurse is caring for a client who has diverticulitis and a new prescription for a low-fiber diet. Which of the following food items should the nurse remove from the clients meal tray? A. Canned fruit B. White bread C. Broiled hamburger D. Coleslaw
Coleslaw This is a high fiber item, clients who are following a low-fiber diet should avoid most raw vegetables
Bleeding: not common during BM Ulcerative colitis Crohns disease
Crohns disease
Colon wall: cobblestone appearance and thickened Ulcerative colitis Crohns disease
Crohns disease
Inflammation pattern: may occur in patches in one or more organs in the digestive system. For instance, a diseased section of the colon may appear between two healthy areas Ulcerative colitis Crohns disease
Crohns disease
PAIN: RLQ Ulcerative colitis Crohns disease
Crohns disease
Smoking: smoking is associated with a worse disease course, patients and may increase the risk of relapses and surgery Ulcerative colitis Crohns disease
Crohns disease
age & gender- any age, adolescents and young adults more common Ulcerative colitis Crohns disease
Crohns disease
Complete displacement or separation of the articular surfaces of the joint. it results from severe injury of the ligaments surrounding the joint. Results from forces transmitted to the joint and disrupt the soft tissue support structures surrounding it. Upper extremity thumb, elbow, shoulder. Lower extremity Hip kneecap Dislocation Subluxation
Dislocation
IBS management
Emotional support (counseling and therapy) High fiber diet raw veggies and fruits SSRI (selective serotonin reuptake inhibitors) for patients who are depressed
Appendicitis cause
Fecalith (a hard stony mass of feces) Inflammation Neoplasm
Signs and symptoms of ulcers
Gnawing epigastric pain GI bleeding: Melena (black stool), hematemesis(bloody vomit), or coffee ground emesis
A nurse is reviewing the medical record of a female client. Which of the following findings should the nurse identify as a risk factor for osteoporosis? A. Decreased intake of phosphate-containing foods B. Spending several hours in the sun daily C. Increased estrogen levels D. History of anorexia nervosa
History of anorexia nervosa The nurse should identify anorexia nervosa as a risk factor because inadequate protein intake can lead to decreased bone density increasing the risk of fractures
A nurse is assessing a client with rheumatoid arthritis who has been taking high doses of prescribed hydroxychloroquine. Which of the following client statements should indicate to the nurse that the client is experiencing an adverse effect of hydroxychloroquine? A. I have developed sores in my mouth B. I often feel like the room is spinning C. I noticed that the whites of my eyes look yellow D. I have had a change in my vision recently
I have had a change in my vision recently the nurse should identify that hydroxychloroquine is an antimalarial medication used to treat rheumatoid arthritis. Clients who take hydroxychloroquine in high doses are at risk for developing retinopathy, which can be irreversible and cause blindness
A nurse is providing teaching for a client who has gout and a prescription for allopurinol. Which of the following statements by the client should indicate to the nurse that the teaching was effective? A. I should start taking this medication at 800 mg daily B. I will have an increased risk for diabetes with this medication C. I will increase my fluids to at least 2 liters per day D. I should take this medication twice daily
I will increase my fluids to at least 2 liters per day the client is encouraged to drink at least 2000 mL/day to maintain a urine output of at least 2 L/Day
A nurse is teaching a client who has a new prescription for alendronate for the treatment of osteoporosis. Which of the following statements by the client indicates an understanding of the teaching? A. I will take the medication in the evening B. I will drink a full glass of milk with the medication C. I will take the medication at mealtime D. I will sit upright after taking the medication
I will sit upright after taking the medication A client taking alendronate should sit upright for 30 minutes after administration to prevent esophageal irritation and ulceration. Therefore the nurse should identify this statement as indicating an understanding of the teaching
A nurse it teaching a client who has osteoporosis and a new prescription for alendronate. Which of the following client statements indicates that the teaching was effective? A. I should take the medication with a glass of orange juice B. I will allow the medication to dissolve in my mouth C. I will sit upright for 30 minutes after taking the medication D. I should take the medication right after eating breakfast
I will sit upright for 30 minutes after taking the medication
Promotility
Increase the rate of gastric emptying Metoclopramide helps with nausea and vomiting, heartburn, boating by promoting gastric emptying (no effect on gastric acid)
Appendicitis
Inflammation of the appendix; if untreated gangrene and performation may develop within 36 hours most common in 18-30 year old
H2 Blockers (histamine 2 receptor blockers)
Inhibits gastric acid secretion competitive inhibition of H2 receptors of the gastric parietal cells Treatment of GERD, duodenal ulcer Meds: famotidine, ranitidine
A nurse is providing teaching to a client who has ulcerative colitis and a new prescription for sulfasalazine. The nurse should instruc tthe client to monitor for which of the following adverse effects of this medication? A. Jaundice B. Constipation C. Oral candidiasis D. Sedation
Jaundice Sulfasalazine can cause a yellow discoloration of the skin and yellow/orange discoloration of the urine. The nurse should instruct the client to notify the provider if these occur.
Symptoms of shock
Low BP cold and clammy Change of level of conciseness Change in size of pupil No urine output or ileostomy/colostomy output (12 hr )
Gastritis
NSAIDS have a irritating effect on gastric mucosa Nicotine reduces the secretion of pancreatic bicarb that inhibits neutralization of gastric acid Alcohol on a daily basis can lead to gastritis NSAIDs can be beneficial for stroke patient
Diagnostic gastroenteritis
Not indicated unless symptoms last longer than 72 hours or blood is noted in the stool stool for cultures WBC and Ovum and parasite Stool may be guaiac positive if a bacterial infection is present
Signs and symptoms of carpal tunnel
Numbness tingling/burning pain exacerbated with dorsiflexion of wrist
Pain tool
OLD CART Onset Location Duration Characteristics Aggravating factor Relieving factor Treatment
Risk of perforation
Pt will be at risk for peritonitis which presents as rigid, tender, board-like abdomen dangerous or life threatening and needs urgent care Inflammation of peritonium, the membrane that lines the inner abdominal wall and encloses organs within the abdomen.
Physical findings of appendicitis
RLQ: guarding with rebound tenderness PSOA sign: pain with right thigh extension Obturator sigh: Pain with internal rotation of flexed right thigh Positive Rovsing sign: RLQ when pressure is applied to the LLQ Low grade fever McBurney's Point tenderness
A nurse is providing discharge teaching to a client who has osteoarthritis. Which of the following instructions should the nurse include? A. Rest frequently after periods of activity B. Perform your exercises only on days that you feel good C. Perform your exercises after applying cold packs to your joints D. Place a large pillow under your knees when lying down
Rest frequently after periods of activity The joint pain in osteoarthritis is caused by deterioration of the synovial membranes and often worsens after activity. Rest usually helps relieve the pain so performing activities at a comfortable pace with periods of rest is appropriate
Auto immune, an insult precipitates and autoimmune reaction activating antibody-complement complexes resulting in endothelial activation, synovial hypertrophy and joint inflammation/damage. 50% attributable to genetic causes
Rheumatoid arthritis
LABS: ESR C-reactive protein usually elevated ANA + in 1/5 patients
Rheumatoid arthritis
Methotrexate Interleukin-6 receptor antagonist to slow disease progression NSAIDS Naproxen or ibuprofen Corticosteroids Physical therapy and rest
Rheumatoid arthritis
A nurse is providing dietary teaching to a client who has ulcerative colitis. Which of the following food selections by the client indicates an understanding of the teaching? A. Raw vegetable salad with low-fat dressing B. Roast chicken and white rice C. Fresh fruit salad and milk D. Peanut butter on whole wheat bread
Roast chicken and white rice Clients who have ulcerative colitis are restricted to a low-fiber which omits whole grains and raw fruits and vegetables. Roast chicken with white rice is the best choice
IBS diagnostic
Sigmoidoscopy Barium studies
Tear or severe stretch injury to tendon or muscle. Tendons connect bones and muscle. Strain Sprain Avulsion
Strain
Partial or incomplete displacement of the joint surface. Less severe Dislocation Subluxation
Subluxation
PPI
Take 30 minutes before meals Suppresses gastric acid secretions Treatment: Peptic ulcers, GERD, heartburn, stress ulcer prophylaxis Meds: pantoprazole, omeprazole
A nurse in a providers office is providing teaching to a client with osteoporosis who has a new prescription for alendronate sodium. Which of the following pieces of information should the nurse include? A. Alendronate sodium can be administered by IV once yearly B. Take alendronate sodium with a full glass of water on an empty stomach C. Side effects of alendronate sodium include leukopenia D. Alendronate sodium should be taken with calcium-containing foods to increase absorption
Take alendronate sodium with a full glass of water on an empty stomach take on an empty stomach 30 mins before breakfast with 8oz of water
Colon wall- thinned Ulcerative colitis Crohns disease
Ulcerative colitis
LLQ Ulcerative colitis Crohns disease
Ulcerative colitis
Tends to be continuous throughout the inflamed areas. In many cases, begins in the rectum or sigmoid colon and spreads up through the colon as the disease progresses. Ulcerative colitis Crohns disease
Ulcerative colitis
Gastroenteritis
a nonspecific term usually applied to a syndrome of acute nausea, vomiting, diarrhea, and cramping, resulting from an acute inflammation/irritation of the gastric mucosa AKA stomach bug/flu
IBS signs and symptoms
abdominal cramping Abdominal pain relieved by defecating (pooping) Changes in stool consistency and or pattern Anxiety or depression
A nurse is reviewing the medical record of a client who has a prescription for probenecid to treat gout. The nurse should identify that which of the following medications can interact with probenecid? A. Colchicine B. Naproxen C. Aspirin D. Prednisone
aspirin Aspirin can decrease the effectiveness of probenecid. The nurse should caution the client to avoid interaction between probenecid and salicylate medications
Sign and symptoms of colon cancer
-Often asymptomatic until complications occur eg bowel obstruction -Early disease: nonspecific finidngs (fatigue, weight loss) or none at all -More advanced disease: abdominal tenderness, palpable abdominal mass, hepatomegaly, ascites -changes in bowel habits or blood in stool -thin stools -weight loss
A nurse is providing teaching to a client who has gout and urolithiasis. The client askes how to prevent future uric acid stones. Which of the following suggestions should the nurse provide? A. Take allopurinol as prescribed B. Exercise several times a week C. Limit intake of foods high in purine D. Decrease daily fluid intake E. Avoid citrus juices
A. Take allopurinol as prescribed B. Exercise several times a week C. Limit intake of foods high in purine
Fibromyalgia meds
Amitriptyline at bedtime Pregabalin Gabapentin SNRI Non therapeutic: Accupuncture Biofeedback Yoga
A nurse in an acute care clinic is talking with a client who reports that the osteoarthritis pain in her knees is increasing each day. The client wants to discuss non-pharmacological approaches to help relieve her pain. Which of the following interventions should the nurse suggest? A. Applying warm compresses to sore joints B. Decreasing the daily intake of dietary protein C. Keeping joints in extension during rest periods D. Limiting sleep to 6 to 7 hr per night
Applying warm compresses to sore joints warm packs or warm soaks are often effective for relieving arthritic pain
Lactose intolerance
Avoid: milk, ice cream, and cheese can tolerate yogurt
Injury in which a body structure is torn off by either trauma or surgery. Anybody part can be affected: Skin, tendon, ligament, bone etc. Strain Sprain Avulsion
Avulsion
A nurse is talking with an older adult client who has an elevated risk for osteoporosis about strategies for preventing bone loss. Which of the following instructions should the nurse provide? A. Begin a program of brisk walking B. Take 800 mg of calcium per day C. Drink plenty of sparkling water D. Drink 8ox of red wine each day
Being a program of brisk walking Weight bearing exercises help maintain bone mass and prevent osteoporosis. Walking is generally a safe activity for older clients
Pressure with the examiner's thumb over the patients carpal tunnel for 30 seconds elicits the symptoms Positive Tinel's test Positive Phalen's test Carpal compression test
Carpal compression test
A nurse is performing medication reconciliation for a newly admitted client who has rheumatoid arthritis. which of the following medications should the nurse identify as the treatment for this condition? A. Misoprostol B. Dantrolene C. Celecoxib D. Colchicine
Celecoxib Celecoxib is a type of NSAID known as cyclooxygenase-2 (COX-2) inhibitors that are used to relieve some of the manifestations caused by RA in adults. The nurse should identify that the medication is also prescribed for osteoarthritis, spondylitis and painful menstruation
A nurse is caring for a client who has a new diagnosis of rheumatoid arthritis. The nurse should anticipate a prescription from the provider for which of the following medications for daily management of this condition? A. Celecoxib B. Prednisone C. Adalimumab D. Abatacept
Celecoxib The nurse shoud anticipate that the provider will prescribe celecoxib, which is a nonsteroidal anti-inflammatory drug (NSAID) this medication or another NSAID should be initiated for a client who has anew diagnosis of Rheumatoid arthritis
A nurse is discussing the cuases of chronic diarrhea with a client. Which of the following conditions is caused by malabsorption? A. Celiac disease B. Ulcerative colitis C. Hirschsprung's disease D. Crohn's disease
Celiac disease The nurse should recognize that celiac disease causes chronic diarrhea due to malabsorption. other malabsorption conditions include short-bowel syndrome, lactose intolerance, and congenital enzyme deficiency
A nurse is caring for a client who is experiencing an acute gout attack. The nurse should anticipate a prescription from the provider for which of the following medications? A. Colchicine B. Allopurinol C. Probenecid D. Pegloticase
Colchicine Colchicine is the medication of choice for an acute gout attack. The client can experience relief from the attack within hours of receiving this medication.
Screening for colon rectal cancer
Colonoscopy why? because the entire colon is examined, biopsies can be obtained and polyps can be immediately removed and sent to the lab for examination
A nurse is preparing to administer raloxifene to a client. Which of the following conditions is a contraindication for the administration of this medication A. Osteoporosis B. Hyperthyroidism C. Myocardial infarction D. DVT
DVT Raloxifene like estrogen, increases the risk of DVT, pulmonary embolism, and stroke. Raloxifene is contraindicated for clients who has a history of venous thrombotic events
A nurse is assessing a female client who reports severe joint pain. The nurse should identify that which of the following factors places the client at risk for gout? A. perimenopause B. Migraine headaches C. Diuretic use D. Irritable bowel syndrome
Diuretic use The clients use of diuretics is a risk factor for gout. Gout is a systemic disorder that affects the joints as a result of high uric acid levels in the blood
A nurse is caring for a client who has asthma and advanced rheumatoid arthritis and deformity of the hands. The nurse should anticipate that the client will receive which of the following medication delivery devices for the treatment of asthma? A. Dry powder inhaler (DPI) B. meter-dosed inhaler (MDI) with spacer C. Respimat Nebulizer
Dry-powder inhaler (DPI) The nurse should identify that DPI do not require hand-breath coordination and are easier to use for clients who have deformities of the hands. DPIs are used to deliver medications in a dry, micronized powder directly to the lungs
A nurse is caring for a client who has an acute exacerbation of Crohn's disease. Which of the following actions should the nurse take? A. Ensure bowel rest B. Offer sparking water frequently C. Administer a stool softener D. Offer plain warm tea frequently
Ensure bowel rest Clients who have an exacerbation of Crohn's disease usually require NPO status to ensure bowel rest and promote healing and recovery
A nurse is providing dietary teaching to a client who has diverticulitis about preventing acute attacks. Which of the following foods should the nurse recommend? A, Foods high in vitamin C B. Foods low in fat C. Foods high in fiber D. Foods low in calories
Foods high in fiber Long term low fiber eating habits and increased intracolonic pressure lead to straining during bowel movements causing the development of diverticula. High-fiber foods help strengthen and maintain the active motility of the GI tract
A nurse is caring for a client who has osteoporosis and a new prescription for prescription for calcium supplements. Which of the following foods should the nurse recommend to promote calcium absorption? A. Fortified milk B. Ripe Bananas C. Steamed broccoli D. Green leafy vegetables
Fortified milk Fortified milk provides 2.45 mcg of vitamin D, which promotes calcium absorption from the gastrointestinal tract. Adults up to age 70 need 600 international units of vitamin d per day and 800 internation units thereafter. Therefore, fortified milk is a good source of vitamin D
A nurse is teaching a client who has severe generalized rheumatoid arthritis and is scheduled to start taking prednisone for long-term therapy. The nurse should instruct the client to report which of the following as an adverse effect of prednisone? A. Ototoxicity B. Immunosuppression C. Gastric Ulceration D. Liver toxicity
Gastric ulceration long term use will cause gastric ulceration and osteoporosis
A nurse is assessing a client who has osteoarthritis. The clients medical record indicates the presence of herberdens nodes. Which of the following findings should the nurse expect? A. Inflamed, fluid filled sacs over the joints B. Clubbing of the fingernails C. Flexion contracture of the fingers D. Hard lumps over the joints of the fingers
Hard lumps over the joints of the fingers
A nurse is caring for a client who is experiencing an acute exacerbation of rheumatoid arthritis. The nurse should anticipate that the clients affected joints will require which of the following treatments? A. An assistive device when the client is ambulating B. Heat paraffin therapy applied to the clients joints C. Gentle massage of the clients hands D. Active range of motion exercises on the clients affected joints
Heat paraffin therapy applied to the clients joints The nurse should anticipate the use of heat paraffin to be prescribed as a nonpharmacological intervention. An elevated ESR indicates an acute inflammatory process due to clients Rheumatoid arthritis. The use of the warm paraffin relieves the stiffness of the clients joins and provides comfort
A nurse is reviewing the medical record of a client with rheumatoid arthritis who has a prescription for infliximab. Which of the following findings should the nurse identify as a contraindication to the client receiving this medication? A. Psoriatic arthritis B. Hep B virus C. Ulcerative colitis D. Ankylosing spondylitis
Hepatitis B virus The nurse should identify that infliximab is a tumor necrosis factor (TNF) antibody medication that is used to reduce the disease progression. Infliximab has immunosuppressant properties that can increase the risk of infection. Client's who have an active or chronic infection such as hepatitis B virus should not take infliximab
Fluid replacement
Monitor lung sounds for crackles as a sign of fluid overload if patient has fluid overload call doctor for lasix Patients with heart and kidney failure cannot tolerate fluids
Degenerative joint disease with slow destruction of the articular cartilage, wearing away Osteoarthritis Rheumatoid arthritis
Osteoarthritis
A nurse is discussing the difference between rheumatoid arthritis and osteoarthritis with a newly licensed nurse. Which of the following pieces of information should the nurse include about osteoarthritis? A. Osteoarthritis is caused by autoimmune processes B. Osteoarthritis leads to decreased erythrocyte sedimentation rate C. Osteoarthritis affects other organ systems D. Osteoarthritis can impair a joint on a single side of the body
Osteoarthritis can impair a joint on a single side of the body
A nurse is discussing the difference between rheumatoid arthritis (RA) and osteoarthritis with a newly licensed nurse. Which of the following pieces of information should the nurse include about osteoarthritis? A. Osteoarthritis is caused by autoimmune processes B. Osteoarthritis leads to decreased erythrocyte C. Osteoarthritis affects other organ systems D. Osteoarthritis can impair a joint on a single side of the body
Osteoarthritis can impair a joint on a single side of the body the nurse should identify unilateral joint involvement as a finding of osteoarthritis. A client who has RA experiences symmetrical joint impairment
Reproduction of symptoms after 1 minute of wrist flexion Positive Tinel's test Positive Phalen's test Carpal compression test
Phalen's test
Treatment for strain, sprain, and avulsion
Protection rest Ice Compression Elevate
Anti-gout
Reduces SUA serum uric acid
A nurse is caring for a client who has rheumatoid arthritis and a new prescription for etanercept. Which of the following values should the nurse review prior to the administration of the medication? A. Ability to swallow B. Results of last purified protein derivative (PPD) test C. Serum creatinine level D. Blood glucose level
Results of last purified protein derivative (PPD) test The nurse should identify that a client who is taking etanercept is at risk for infections such as TB to reduce this risk the client should be tested for latent TB if the test is positive the client should undergo TB treatment before receiving etanercept. During treatment with etanercept the client should be monitored closely for the development of TB
Inflammation is symmetrical and occurs in 3:1 women
Rheumatoid arthritis
DMARDs (disease modifying anti-rheumatic drugs)
Slows joint degeneration in rheumatoid arthritis
Injury to a ligament. Ligaments connect bone to bone Strain Sprain Avulsion
Sprain
A nurse is preparing a client who is scheduled to have arthroscopy the following day. Which of the following statements indicates that the client understands the pre-procedure teaching? A. I have to keep my leg straight throughout the whole procedure B. The doctor will be able to see if i have signs of rheumatoid arthritis C. I should expect to stay overnight until i can walk around D. I'll have a scar that will be about an inch long
The doctor will b able to see if i have signs of Rheumatoid arthritis
Tapping over the median nerve on the flexor surface of the wrist produces a tingling sensation radiating from the wrist to the hand Positive Tinel's test Positive Phalen's test Carpal compression test
Tinel's test
What can cause a large bowel obstruction?
Tumor or polyps
A nurse is preparing a community education program about reducing the risk of osteoporosis. Which of the following pieces of information should the nurse include? A. Avoid sun exposure B. Take a calcium supplement once each day if at risk for osteoporosis C. Walking is the preferred mode of exercise to maintain strong bones D. Caffeine intake minimizes the risk of developing osteoporosis
Walking is the preferred mode of exercise to maintain strong bones The nurse should emphasize that regular walks are the preferred weight-bearing exercise to build and maintain strong bones
A nurse is caring for a client who was recently diagnosed with rheumatoid arthritis. The nurse should expect the provider to prescribe methotrexate at which of the following times? A. Within 3 months of the initial diagnosis B. when NSAIDS have not provided pain relief C. During an exacerbation of symptoms D. Once bone degeneration progresses
Within 3 months of the initial diagnosis To prevent or delay joint degeneration Glucocorticoids are used to control symptoms of RA until DMARD take effect
A nurse is caring for a client who has recovered from acute diverticulitis. The nurse should instruct the client to increase his intake of which of the following foods when the inflammation subsides? A. cucumbers and tomatoes B. cabbage and peaches C. Strawberries and corn D. Figs and nuts
cabbages and peaches when the acute inflammation has subsided the client should increase his intake of foods that are high in fiber such as wheat bran, whole grain bread and fresh fruits and vegetables that do not contain seeds Seeds can contribute to obstructing the diverticulum and cause or worsen inflammation
Median nerve compression of the wrist beneath the transverse carpal ligament
carpal tunnel syndrome
a nurse is caring for a client who is taking budesonide to treat crohns disease. which of the following findings should indicate to the nurse that the treatment is effective? A. decreased blood glucose B. Increased potassium C. Increased prostaglandin synthesis D. decreased inflammation
decreased inflammation for a client who has crohns disease a decreased inflammation of the gastrointestinal lining of the clients large intestines is a therapeutic effect of taking budesonide. Budesonide is a glucocorticoid that works by suppressing the immune system. Glucocorticoids inhibit the actions of prostaglandins and leukotrienes.
A nurse is providing teaching to a client who is scheduled to start taking alendronate sodium. Which of the following recommendations should the nurse include in the teaching? A. The medication may be crushed if you have difficulty swallowing it B. Drink a full glass of milk when you take the medication C. Take the medication at bedtime D, Discontinue the medication if you develop heartburn
discontinue the medication if you develop heartburn stop taking the medication if heartburn develops or worsens and contact provider. This is an indication the esophageal irritation has occurred.
A nurse is teaching a group of clients at a senior center about the risk factors for osteoporosis. Which of the following statements should the nurse include in the teaching? A. Extended periods of immobility increase your risk of osteoporosis B. Prolonged periods of sun exposure increase your risk of osteoporosis C. Eating a diet high in protein can reduce your risk of osteoporosis D. Corticosteroid therapy will reduce your risk of osteoporosis
extended periods of immobility increase your risk of osteoporosis Osteoporosis is a disorder of weakened bones due to a loss of bone mass and a change in bone structure. Immobility can result in osteoporosis, therefore weightbearing exercise such as walking can prevent osteoporosis.
Colon cancer risk factors
family history high fat diet refined carbs polyps
Diagnostic for colon cancer
fecal occult blood test colonoscopy CBC Carcinoembryonic antigen elevated - nonsmokers <2.5 smokers <5 Screening at the age of 50
A nurse is providing teaching to a client who has gout and a new prescription for allopurinol. The nurse should instruct the client to discontinue taking the medication for which of the following adverse effects? A. Nausea B. Metallic taste C. Fever D. Drowsiness
fever a fever can indicate a potentially fatal hypersensitivity reaction. The client should discontinue allopurinol and notify the provider if a fever or rash develops
A nurse is reviewing the medical record of a client who has postmenopausal osteoporosis and a prescription for raloxifene. Which of the following findings in the clients medical record should the nurse identify as a contraindication to receiving this medication? A. Breast cancer B. history of DVT C. Allergy to calcitonin D. Current diagnosis of cholecystitis
history of DVT an alternative medication request needs to be made because it can cause a DVT in pts with a previous history
Enema administration
hold the container of solution 30-45 cm above the anus to allow for continuous slow installation of solution
A nurse is teaching a female client who has a new prescription for misoprostol to treat peptic ulcer disease. Which of the following client statements should indicate to the nurse that the teaching was effective? A. I should avoid taking NSAIDS while using this medication B. Misoprostol is used to treat stress-induced gastric ulcers C. I should avoid becoming pregnant while taking this medication D. This medication is also used to treat dysmenorrhea
i should avoid becoming pregnant while taking this medication The nurse should identify that misoprostol is contraindicated during pregnancy and is classified as pregnancy risk category x by the food and drug administration. it has the potential to stimulate uterine contractions and the use of misoprostol during pregnancy has been known to cause partial or complete expulsion of the developing fetus
A nurse is caring for an older adult client who has gout and refuses to eat. The clients provider has authorized the client's family to bring food from home. Which of the following foods should the nurse recommend that the client avoid? A. Lentil soup B. Cheese sandwich C. Yogurt D. Raisins
lentil soup The nurse should encourage the client to eat a purine restricted diet to decrease elevated uric acid levels. This diet is recommended for clients who have gout, renal calculi or both in conjunction with medication therapy. Whole-grain break and cereal, oatmeal, wheat germ, wheat bran, meat gravy, fresh and saltwater fish, beans, organ meats mushrooms, green peas spinach, asparagus, cauliflower, and bakers and brewers yeast are all high in purine. Lentils is a rich source of purine
A nurse is assessing a client who has several risk factors for osteoporosis. Which of the following findings indicates that the client requires further evaluation for this disorder? A. Leg cramps with exercise B. Stress incontinence C. Abdominal distention D. Lower back pain
lower back pain lower back pain is common among clients who has osteoporosis, especially when they lift, stoop or bend. Back pain and tenderness that cause movement restriction might indicate vertebral compression fractures which are the most common type of fractures resulting from osteoporosis
A nurse is caring for a client who has ulcerative colitis. The provider prescribes bed rest with bathroom privileges. When the client askes the nurse why he has to stay in bed, which of the following responses should the nurse provide? A. You need to conserve energy at this time B. Lying quietly in bed helps slow down the activity in your intestines C. Staying in bed promotes the rest and comfort you need D. Staying in bed will help prevent injury and minimize your fall risk
lying quietly in bed helps slow down the activity in your intestines The greatest risk to the client is complications from severe diarrhea such as dehydration, electrolyte imbalances, and gastrointestinal bleeding and trauma. Activity restriction can help reduce intestinal peristalsis and diarrhea.
A nurse is preparing to administer medication to a client who has gout. The nurse discovers that an error was made during the previous shift in which the client received atenolol instead of allopurinol. Which of the following interventions is the nurse priority? A. Measure the clients apical pulse B. Administer the allopurinol to the client C. Inform the nurse manager D. Complete an incident report
measure the clients apical pulse The first action the nurse should take using the nursing process is to assess the client by measuring the clients apical pulse. Atenolol is a beta blocker and can decrease the clients heart rate
A nurse is caring for a client who is experiencing an acute gout attack. The nurse should anticipate a prescription from the provider for which of the following medications? A. Naproxen B. Pegloticase C. Probenecid D. Allopurinol
naproxen The nurse should anticipate that the provider will prescribe an NSAID such as naproxen. This type of medication is recommended as the first choice of treatment for relieving the manifestations of an acute gout attack
Oral infection treatment Candida albican herpes ginivitis
nystatin antiviral dentist referral
Inflammation is asymmetrical and in men and women 30-40 years of age
osteoarthritis
Diverticulitis
perforation occurs present with sudden abdominal tenderness, need to contact health care provider
A nurse is teaching a client who has osteoporosis. Which of the following instructions should the nurse include in the teaching? A. Reduce dietary protein intake B. Apply ice to painful areas C. Increase calcium intake to 900 mg per day D. Perform weight-bearing exercises
perform weight-bearing exercises The nurse should instruct the client to perform weight-bearing exercises to promote bone formation and increase strength and mobility
A nurse is caring for a female client who has osteoporosis and is taking Raloxifene. Which of the following findings should indicate to the nurse that the client is experiencing an adverse effect of this medication? A. Severe leg cramps B. Urinary frequency C. Jaw Pain D. Sudden onset of dyspnea
sudden onset of dyspnea The nurse should identify that raloxifene is a selective estrogen receptor modulator which can have estrogenic effects in some tissues and antiestrogenic effect in other tissues. Clients who are taking raloxifene have an increased risk of thromboembolic events such as DVT, pulmonary embolism, or stroke. Therefore the nurse should notify the provider if the client is experiencing this adverse effect of raloxifene
A nurse is teaching a client who is postmenopausal and has a prescription for alendronate Which of the following statements should the nurse include in the teaching? A. You can lie down 15 minutes after taking this medication B. Take this medication on an empty stomach C. Crush his medication to improve absorption D. Avoid taking antacids or supplements that contain calcium while taking this medication
take this medication on an empty stomach The nurse should instruct the client to avoid taking alendronate with food or liquids other than water because it can decrease absorption. The client should only take this medication with water 30 minutes before breakfast
A nurse is planning a presentation for a group of older adults at a community center about risk factors for cancer. Which of the following factors increases the risk for developing cancer after the age of 60? A. high-protein diet B. Insufficient calcium C. Declining muscle mass D. Weakened immune response
weakened immune response after age 60 clients have a high risk of cancer due to hormonal changes, altered immune responses and the accumulation of free radicals. Age is a significant factor because the longer people are exposed to external carcinogenic factors (eg tobacco alcohol environmental pollutants, radiation) the greater their risk of developing cancer becomes High fat, low fiber diet is a risk factor for developing colon cancer
A nurse is caring for a client who has acute diverticulitis. WHile the client has active inflammation the nurse should instruct the client to include which of the following foods in her diet? A. White bread and plain yogurt B. Shredded wheat cereal and blueberries C. Broccoli and kidney beans D. Oatmeal and fresh pears
white bread and plain yogurt Because of the acute inflammation of diverticulitis, the client should maintain a diet very low in fiber. The client can consume low-fiber foods like white bread, low-fat milk, yogurt with active cultures, poached eggs and canned soft fruit
