CHA 2 Exam 2
Anaphylaxis
-Reaction happens within minutes -Can be life threatening: hypovolemic shock r/t capillary permiability.
Normal AST
0-35 U/L
Normal platelets
150,000 - 400,000
Normal neutrophil count
1500-6600 or 55 to 70%
Normal ALT
4-36 U/L
Normal white blood cell county
5000 to 10000
A 25-yr-old female patient with systemic lupus erythematosus (SLE) has a facial rash and alopecia. She tells the nurse, "I never leave my house because I hate the way I look." Which patient problem should the nurse plan to address? a. Social isolation b. Activity intolerance c. Impaired skin integrity d. Impaired social interaction
A
A child with osteomyelitis asks the nurse, What is a sed rate? What is the best response for the nurse? a. It tells us how you are responding to the treatment. b. It tells us what type of antibiotic you need. c. It tells us whether we need to immobilize your extremity. d. It tells us how your nerves and muscles are doing.
A
A patient has a new order for magnetic resonance imaging (MRI) to evaluate possible left femur osteomyelitis after hip arthroplasty surgery. Which information indicates the nurse should consult with the health care provider before scheduling the MRI? a. The patient has a pacemaker. b. The patient wears a hearing aid. c. The patient is allergic to shellfish. d. The patient uses supplemental oxygen.
A
A patient with dermatomyositis is receiving long-term prednisone therapy. Which assessment finding should the nurse report immediately to the health care provider? a. The patient has painful hematuria. b. Acne is noted on the patient's face. c. Fasting blood glucose is 112 mg/dL. d. The patient has an increased appetite.
A
An older adult who takes medications for coronary artery disease and hypertension is newly diagnosed with HIV infection and is starting antiretroviral therapy. Which information will the nurse include in patient teaching? a. Many drugs interact with antiretroviral medications. b. HIV infections progress more rapidly in older adults. c. Less frequent CD4+ level monitoring is needed in older adults. d. Hospice care is available for patients with terminal HIV infection.
A
Eight years after seroconversion, a patient with human immunodeficiency virus infection has a CD4+ cell count of 800/μL and an undetectable viral load. What should be included in the plan of care at this time? a. Encourage adequate nutrition, exercise, and sleep. b. Teach about the side effects of antiretroviral agents. c. Explain opportunistic infections and antibiotic prophylaxis. d. Monitor symptoms of acquired immunodeficiency syndrome (AIDS).
A
The nurse is advising a patient who was exposed 4 days ago to human immunodeficiency virus (HIV) through unprotected sexual intercourse. The patient's antigen-antibody test has just been reported as negative for HIV. What information should the nurse give to this patient? a. "You will need to be retested in 2 weeks." b. "You do not need to fear infecting others." c. "We won't know for about 10 years if you have HIV infection." d. "With no symptoms and this negative test, you do not have HIV."
A
To evaluate the effectiveness of antiretroviral therapy (ART), which laboratory test result will the nurse review? a. Viral load testing b. Enzyme immunoassay c. Rapid HIV antibody testing d. Immunofluorescence assay
A
Which action should the nurse include when performing the straight-leg raising test for an ambulatory patient with back pain? a. Lift the patient's leg to a 60-degree angle from the bed. b. Place the patient in the prone position on the exam table. c. Ask the patient to dangle both legs over the edge of the exam table. d. Instruct the patient to elevate the legs and tense the abdominal muscles.
A
Which action should the nurse take when caring for a patient with osteomalacia? a. Teach about the use of vitamin D supplements. b. Educate about the need for weight-bearing exercise. c. Instruct the patient to avoid dairy products in the diet. d. Discuss the use of medications such as bisphosphonates.
A
Which finding for a patient who is taking hydroxychloroquine (Plaquenil) to treat rheumatoid arthritis should the nurse identify as a likely adverse effect of the medication? a. Blurred vision b. Joint tenderness c. Abdominal cramping d. Elevated blood pressure
A
The nurse is caring for a patient living with asymptomatic chronic HIV infection (HIV). Which prophylactic measures will the nurse include in the plan of care? (Select all that apply.) a. Hepatitis B vaccine b. Pneumococcal vaccine c. Influenza virus vaccine d. Trimethoprim-sulfamethoxazole e. Varicella zoster immune globulin
A, B, C
In which order should the nurse implement interventions prescribed for a patient admitted with acute osteomyelitis who has a temperature of 101.2° F? (Put a comma and a space between each answer choice [A, B, C, D].) a. Obtain blood cultures from two sites. b. Administer dose of gentamicin 60 mg IV. c. Send to radiology for computed tomography (CT) scan of right leg. d. Administer acetaminophen (Tylenol) now and every 4 hours PRN for fever.
A, B, D, C
A nurse is caring for a 78-year-old client with severe, debilitating rheumatoid arthritis who lives at home with the spouse. The nurse assesses the client's level of safety in the home. Which aspects should be included as part of this home safety assessment? Select all that apply. A. Whether there is sufficient lighting B. Whether there is space available for a caregiver to help with the client C. Whether the home has ceiling fans D. Whether there are changes in floor levels E. Whether there are stairs in the home
A, B, D, E
Which actions should the nurse include in the plan of care for a patient with metastatic bone cancer of the left femur? (Select all that apply.) a. Monitor serum calcium. b. Teach about the need for strict bed rest. c. Explain the use of sustained-release opioids. d. Support the left leg when repositioning the patient. e. Assist family and patient as they discuss the prognosis.
A, C, D, E
A patient with muscular dystrophy is hospitalized with pneumonia. Which nursing action should the nurse include in the plan of care? a. Logroll the patient every 2 hours. b. Assist the patient with ambulation. c. Discuss the need for genetic testing with the patient. d. Teach the patient about the muscle biopsy procedure.
B
Extraarticular manifestations
Affects all body systems. Sjogren's: dry eyes, photosensitivity. Felty: enlarged spleen, low WBC, increased risk of infection.
Pathophysiology of RA
Antigen triggers formation of abnormal IgG. Autoantibodies develop against the abnormal IgG. Rheumatoid factor combines with IgG to form immune complexes that deposit in synovial joints. Leads to activation of complement and inflammatory response.
A 29-yr-old woman is taking methotrexate to treat rheumatoid arthritis. Considering this treatment, which information should the nurse report to the health care provider? a. The patient had a history of infectious mononucleosis as a teenager. b. The patient is trying to get pregnant before her disease becomes more severe. c. The patient has a family history of age-related macular degeneration of the retina. d. The patient has been using large doses of vitamins and health foods to treat the RA.
B
A nurse who works on the orthopedic unit has just received change-of-shift report. Which patient should the nurse assess first? a. Patient who reports foot pain after hammertoe surgery. b. Patient who has not voided 8 hours after a laminectomy. c. Patient with low back pain and a positive straight-leg-raise test. d. Patient with osteomyelitis who has a temperature of 100.5° F (38.1° C).
B
A patient has recently been diagnosed with rheumatoid arthritis (RA) The patient, who has two school-age children, tells the nurse that home life is very stressful. Which initial response should the nurse make? a. "You need to see a family therapist for some help with stress." b. "Tell me more about the situations that are causing you stress." c. "Perhaps it would be helpful for your family to be in a support group." d. "Your family should understand the impact of your rheumatoid arthritis."
B
A patient is being discharged after 1 week of IV antibiotic therapy for acute osteomyelitis in the right leg. Which information should the nurse include in the discharge teaching? a. How to apply warm packs to the leg to reduce pain b. How to monitor and care for a long-term IV catheter c. The need for daily aerobic exercise to help maintain muscle strength d. The reason for taking oral antibiotics for 7 to 10 days after discharge
B
A patient whose employment requires frequent lifting has a history of chronic back pain. After the nurse has taught the patient about correct body mechanics, which patient statement indicates the teaching has been effective? a. "I will keep my back straight when I lift above than my waist." b. "I will begin doing exercises to strengthen and support my back." c. "I will tell my boss I need a job where I can stay seated at a desk." d. "I can sleep with my hips and knees extended to prevent back strain."
B
A patient with Hodgkin's lymphoma who is undergoing external radiation therapy tells the nurse, "I am so tired I can hardly get out of bed in the morning." Which intervention should the nurse add to the plan of care? a. Minimize activity until the treatment is completed. b. Establish time to take a short walk almost every day. c. Consult with a psychiatrist for treatment of depression. d. Arrange for delivery of a hospital bed to the patient's home.
B
A patient with acute osteomyelitis of the left femur is hospitalized for regional antibiotic irrigation. Which intervention should the nurse include in the initial plan of care? a. Quadriceps-setting exercises b. Immobilization of the left leg c. Positioning the left leg in flexion d. Assisted weight-bearing ambulation
B
A pregnant woman with asymptomatic chronic human immunodeficiency virus (HIV) infection is seen at the clinic. The patient states, "I am very nervous about making my baby sick." Which information will the nurse include when teaching the patient? a. The antiretroviral medications used to treat HIV infection are teratogenic. b. Most infants born to HIV-positive mothers are not infected with the virus. c. Because it is an early stage of HIV infection, the infant will not contract HIV. d. Her newborn will be born with HIV unless she uses antiretroviral therapy (ART).
B
Anakinra (Kineret) is prescribed for a patient with rheumatoid arthritis (RA). What information should the nurse include in teaching the patient about this drug? a. Avoiding aspirin use. b. Giving subcutaneous injections. c. Taking the medication with water. d. Recognizing gastrointestinal bleeding.
B
How should the nurse suggest that a patient recently diagnosed with rheumatoid arthritis (RA) plan to start each day? a. A brief routine of isometric exercises b. A warm bath followed by a short rest c. Active range-of-motion (ROM) exercises d. Stretching exercises to relieve joint stiffness
B
The health care provider has prescribed the following interventions for a patient who is taking azathioprine (Imuran) for systemic lupus erythematosus. Which order should the nurse question? a. Draw anti-DNA blood titer. b. Administer varicella vaccine. c. Naproxen 200 mg twice daily. d. Famotidine (Pepcid) 20 mg daily.
B
The nurse administers an IV vesicant chemotherapeutic agent to a patient. Which action is most important for the nurse to take? a. Infuse the medication over a short period of time. b. Stop the infusion if swelling is observed at the site. c. Administer the chemotherapy through a small-bore catheter. d. Hold the medication unless a central venous line is available.
B
The nurse is caring for a patient who is using Buck's traction after a hip fracture. Which action can the nurse delegate to experienced unlicensed assistive personnel (UAP)? a. Remove and reapply traction periodically. b. Ensure the weight for the traction is hanging freely. c. Monitor the skin under the traction boot for redness. d. Check for intact sensation and movement in the affected leg.
B
Which action should the nurse include in the plan of care for a patient with a new diagnosis of rheumatoid arthritis (RA)? a. Instruct the patient to purchase a soft mattress. b. Encourage the patient to take a nap in the afternoon. c. Teach the patient to use lukewarm water when bathing. d. Suggest exercise with light weights several times daily.
B
Which action should the nurse take when repositioning the patient who has just had a laminectomy and discectomy? a. Instruct the patient to move the legs before turning the rest of the body. b. Place a pillow between the patient's legs and turn the entire body as a unit. c. Have the patient turn by grasping the side rails and pulling the shoulders over. d. Turn the patient's head and shoulders first, followed by the hips, legs, and feet.
B
Asymptomatic infection of HIV
left untreated, a diagnosis of AIDS is made about 10 yrs after initial HIV infection. People are typically asymptomatic or have limited signs of infection. High-risk behaviors may continue.
Which assessment information should indicate to the nurse that a patient with an exacerbation of rheumatoid arthritis (RA) is experiencing a side effect of prednisone? a. The patient has joint pain and stiffness. b. The patient's blood glucose is 165 mg/dL. c. The patient has experienced a recent 5-pound weight loss. d. The patient's erythrocyte sedimentation rate (ESR) has increased.
B
Which information should the nurse include when preparing teaching materials for a patient who has an exacerbation of rheumatoid arthritis? a. Affected joints should not be exercised when pain is present b. Applying cold packs before exercise may decrease joint pain c. Exercises should be performed passively by someone other than the patient d. Walking may substitute for range-of-motion (ROM) exercises on some days
B
Which interaction is part of the discharge plan for a school-age child with osteomyelitis who is receiving home antibiotic therapy? a. Instructions for a low-calorie diet b. Arrange for tutoring and school work c. Instructions for a high-fat, low-protein diet d. Instructions for the parent to return the child to team sports immediately
B
Which laboratory result should the nurse monitor to determine if prednisone has been effective for a patient who has an acute exacerbation of rheumatoid arthritis? a. Blood glucose b. C-reactive protein c. Serum electrolytes d. Liver function tests
B
Which patient would benefit from education about HIV preexposure prophylaxis (PrEP)? a. A 23-yr-old woman living with HIV infection. b. A 52-yr-old recently single woman just diagnosed with chlamydia. c. A 33-yr-old hospice worker who received a needle stick injury 3 hours ago. d. A 60-yr-old male in a monogamous relationship with an HIV-uninfected partner.
B
Which statement by a patient with systemic lupus erythematosus (SLE) indicates the patient understands the nurse's teaching about the condition? a. "I will exercise even if I am tired." b. "I will use sunscreen when I am outside." c. "I should avoid nonsteroidal antiinflammatory drugs." d. "I should take birth control pills to avoid getting pregnant."
B
Immunosuppressive therapy
lifelong balance of preventing infection and rejection. Combination of drugs are used- triple therapy. High doses initially then back down. MUST TAKE FOR LIFE.
A high school teacher with ulnar drift caused by rheumatoid arthritis (RA) is scheduled for arthroplasty of several joints in the left hand. Which patient statement to the nurse indicates a realistic expectation for the surgery? a. "This procedure will correct the deformities in my fingers." b. "I will not have to do as many hand exercises after the surgery." c. "I will be able to use my fingers with more flexibility to grasp things." d. "My fingers will appear more normal in size and shape after this surgery."
C
A new clinic patient with joint swelling and pain is having diagnostic tests. Which test should the nurse identify as specific to systemic lupus erythematosus? a. Rheumatoid factor (RF) b. Antinuclear antibody (ANA) c. Anti-Smith antibody (Anti-Sm) d. Lupus erythematosus (LE) cell prep
C
Abnormal blood test in HIV
low WBC: esp lympho and neutro. Low platelets. Anemia associated with ART. Altered liver function.
A patient has inadequate nutrition due to painful oral ulcers. Which nursing action will be most effective in improving oral intake? a. Offer the patient frequent small snacks between meals. b. Assist the patient to choose favorite foods from the menu. c. Apply prescribed anesthetic gel to oral lesions before meals. d. Teach the patient about the importance of nutritional intake.
C
A patient informed of a positive rapid screening test result for human immunodeficiency virus (HIV) is anxious and does not appear to hear what the nurse is saying. What action by the nurse is most important at this time? a. Inform the patient about the available treatments. b. Teach the patient how to manage a possible drug regimen. c. Remind the patient to return for retesting to verify the results. d. Ask the patient to identify those persons who had intimate
C
A patient is receiving IV antibiotics at home to treat chronic osteomyelitis of the left femur. Which statement by the patient should indicate to the nurse the need for additional teaching related to health maintenance? a. "I'm frustrated with this endless treatment!" b. "I will take my oral temperature twice a day." c. "I think my left foot is starting to droop down." d. "I use crutches to avoid weight bearing on the left leg."
C
A patient is taking methotrexate to treat rheumatoid arthritis (RA). Which laboratory result is important for the nurse to communicate to the health care provider? a. Rheumatoid factor is positive. b. Fasting blood glucose is 90 mg/dL. c. The white blood cell count is 1500/μL. d. The erythrocyte sedimentation rate is increased.
C
A patient treated for human immunodeficiency virus (HIV) infection for 6 years has developed fat redistribution to the trunk with wasting of the arms, legs, and face. What recommendation will the nurse give to the patient? a. Review foods that are higher in protein. b. Teach about the benefits of daily exercise. c. Discuss a change in antiretroviral therapy. d. Talk about treatment with antifungal agents.
C
A patient who is diagnosed with acquired immunodeficiency syndrome (AIDS) tells the nurse, "I feel obsessed with morbid thoughts about dying." Which response by the nurse is appropriate? a. "Thinking about dying will not improve the course of AIDS." b. "Do you think that taking an antidepressant might be helpful?" c. "Can you tell me more about the thoughts that you are having?" d. "It is important to focus on the good things about your life now."
C
A patient with a complex pelvic fracture from a motor vehicle crash is on bed rest. Which assessment finding should indicate to the nurse a potential complication of the fracture? a. The patient states the pelvis feels unstable. b. The patient reports pelvic pain with palpation. c. Abdomen is distended, and bowel sounds are absent. d. Ecchymoses are visible across the abdomen and hips.
C
Complications of cancer
malnutrition, altered taste, sever pain, increased risk of infection-primary cause of death.
A patient with metastatic colon cancer has severe vomiting after each administration of chemotherapy. Which action by the nurse is appropriate? a. Have the patient eat large meals when nausea is not present. b. Offer dry crackers and carbonated fluids during chemotherapy. c. Administer prescribed antiemetics 1 hour before the treatments. d. Give the patient a glass of a citrus fruit beverage during treatments.
C
A patient with rheumatoid arthritis (RA) tells the clinic nurse about having chronically dry eyes. Which action should the nurse take? a. Ask the HCP about discontinuing methotrexate. b. Remind the patient that RA is a chronic health condition. c. Suggest the patient use over-the-counter (OTC) artificial tears. d. Teach the patient about adverse effects of the RA medications.
C
After laminectomy with a spinal fusion to treat a herniated disc, a patient reports numbness and tingling of the right lower leg. What action should the nurse take? a. Elevate the right leg on two pillows. b. Obtain vital signs for indication of hemorrhage. c. Review the preoperative assessment data in the health record. d. Turn the patient to the left to relieve pressure on the right leg.
C
External-beam radiation is planned for a patient with cervical cancer. What instructions should the nurse give to the patient to prevent complications from the effects of the radiation? a. Test all stools for the presence of blood. b. Maintain a high-residue, high-fiber diet. c. Clean the perianal area carefully after every bowel movement. d. Inspect the mouth and throat daily for the appearance of thrush.
C
Dermatologic problems of lupus
vascular skin lesions-most common on sun-exposed areas. Butterfly rash. Alopecia, dry itchy scalp.
The nurse instructs a patient who has osteosarcoma of the tibia about a scheduled above-the-knee amputation. Which patient statement indicates to the nurse that additional teaching is needed? a. "I will need to participate in physical therapy after surgery." b. "I wish I did not need to have chemotherapy after this surgery." c. "I did not have this bone cancer until my leg broke a week ago." d. "I can use the patient-controlled analgesia (PCA) to manage postoperative pain."
C
The nurse is caring for a patient who has a pelvic fracture and an external fixation device. How should the nurse perform assessment of pressure areas and provide skin care to the patient's back and sacrum? a. Ask the patient to turn to the side independently. b. Defer back assessment until the patient is ambulatory. c. Have the patient lift the back and buttocks using a trapeze. d. Roll the patient over to the side by pushing on the patient's hips.
C
The second day after admission with a fractured pelvis, a patient suddenly develops confusion. Which action should the nurse take first? a. Take the blood pressure. b. Check the O2 saturation. c. Assess patient orientation. d. Observe for facial asymmetry.
C
What should the nurse include in the teaching plan for ae patient who has acute low back pain and muscle spasms? a. Keep both feet flat on the floor when prolonged standing is required. b. Twist gently from side to side to maintain range of motion in the spine. c. Keep the head elevated slightly and flex the knees when resting in bed. d. Avoid the use of cold packs because they will exacerbate the muscle spasms.
C
What suggestion should the nurse make to a group of women with rheumatoid arthritis (RA) about managing activities of daily living? a. Protect the knee joints by sleeping with a small pillow under the knees. b. Strengthen small hand muscles by wringing out sponges or washcloths. c. Avoid activities requiring repetitive use of the same muscles and joints. d. Stand rather than sit when performing daily household and yard chores.
C
When the nurse brings medications to a patient with rheumatoid arthritis, the patient refuses the prescribed methotrexate. The patient tells the nurse, "My arthritis isn't that bad yet. The side effects of methotrexate are worse than the arthritis." What is the most appropriate response by the nurse? a. "You have the right to refuse to take the methotrexate." b. "Methotrexate is less expensive than some of the newer drugs." c. "It is important to start methotrexate early to decrease the extent of joint damage." d. "Methotrexate is effective and has fewer side effects than some of the other drugs."
C
Which action included in the care of a patient after laminectomy can the nurse delegate to experienced unlicensed assistive personnel (UAP)? a. Check ability to plantar and dorsiflex the foot. b. Determine the patient's readiness to ambulate. c. Log roll the patient from side to side every 2 hours. d. Ask about pain management with the patient-controlled analgesia (PCA).
C
Which exposure by the nurse is most likely to require postexposure prophylaxis when the patient's human immunodeficiency virus (HIV) status is unknown? a. Bite to the arm that does not result in open skin b. Splash into the eyes while emptying a bedpan containing stool c. Needle stick with a needle and syringe used for a venipuncture d. Contamination of open skin lesions with patient vaginal secretions
C
Which nursing action will be most useful in assisting a young adult to adhere to a newly prescribed antiretroviral therapy (ART) regimen? a. Give the patient detailed information about possible medication side effects. b. Remind the patient of the importance of taking the medications as scheduled. c. Help the patient develop a schedule to decide when the drugs should be taken. d. Encourage the patient to join a support group for adults who are HIV positive.
C
Which information should the nurse include when teaching a patient with acute low back pain? (Select all that apply.) a. Sleep in a prone position with the legs extended. b. Keep the knees straight when leaning forward to pick something up. c. Expect symptoms of acute low back pain to improve in a few weeks. d. Avoid activities that require twisting of the back or prolonged sitting. e. Use ibuprofen (Motrin, Advil) or acetaminophen (Tylenol) to relieve pain.
C, D, E
Symptomatic infection of HIV
CD4+ T cells decline closer to 200 cells/uL. HIV advances to a more active stage. Symptoms become worse: persistent fever, frequent night sweats, chronic diarrhea, recurrent headache, severe fatigue. Can still be put on medications but treatment is less effective.
Antiretroviral Therapy
Can significantly slow HIV progression. However is complex, has side effects, does not work for everyone and is expensive. Should be started as soon as possible after diagnosis. Nurses can educate and provide support including medication adherence counseling.
A 68-year-old client suffers from rheumatoid arthritis in the joints of her arms, legs, and hands. The doctor has prescribed oral corticosteroid treatment for the client's condition. Which information should the nurse include about how this medication works to treat arthritis?
Corticosteroids decrease prostoglandins that affect inflammation
A patient has had surgical reduction of an open fracture of the right radius. Which assessment findings should the nurse report immediately to the health care provider? a. Serous wound drainage b. Right arm muscle spasms c. Pain with right arm movement d. Temperature 101.4° F (38.6° C)
D
A patient receiving head and neck radiation for larynx cancer has ulcerations over the oral mucosa and tongue and thick, ropey saliva. Which instructions should the nurse give to this patient? a. Remove food debris from the teeth and oral mucosa with a stiff toothbrush. b. Use cotton-tipped applicators dipped in hydrogen peroxide to clean the teeth. c. Gargle and rinse the mouth several times a day with an antiseptic mouthwash. d. Rinse the mouth before and after each meal and at bedtime with a saline solution.
D
A patient undergoing external radiation has developed a dry desquamation of the skin in the treatment area. The nurse teaches the patient about the management of the skin reaction. Which statement, if made by the patient, indicates the teaching was effective? a. "I can use ice packs to relieve itching." b. "I will scrub the area with warm water." c. "I will expose my skin to a sun lamp each day." d. "I can buy some aloe vera gel to use on my skin."
D
A patient who has a positive test for human immunodeficiency virus (HIV) antibodies is admitted to the hospital with Pneumocystis jiroveci pneumonia (PCP) and a CD4+ count of less than 200 cells/L. Based on diagnostic criteria established by the Centers for Disease Control and Prevention (CDC), which statement by the nurse is correct? a. "The patient meets the criteria for a diagnosis of acute HIV infection." b. "The patient will be diagnosed with asymptomatic chronic HIV infection." c. "The patient will likely develop symptomatic HIV infection within 1 year." d. "The patient has developed acquired immunodeficiency syndrome (AIDS)."
D
A patient who is human immunodeficiency virus (HIV)-infected has a CD4+ cell count of 400/μL. Which factor is most important for the nurse to determine before the initiation of antiretroviral therapy (ART) for this patient? a. CD4+ cell count b. How the patient obtained HIV c. Patient's tolerance for potential medication side effects d. Patient's ability to follow a complex medication regimen
D
An older adult patient who has colorectal cancer is receiving IV fluids at 175 mL/hr in conjunction with the prescribed chemotherapy. Which finding by the nurse is most important to report to the health care provider? a. Patient reports having severe fatigue. b. Patient voids every hour during the day. c. Patient takes only 50% of meals and refuses snacks. d. Patient has crackles up to the midline posterior chest.
D
The home health nurse is making a follow-up visit to a patient recently diagnosed with rheumatoid arthritis (RA). Which finding indicates to the nurse that additional patient teaching is needed? a. The patient takes a 2-hour nap each day. b. The patient has been taking 16 aspirins each day. c. The patient sits on a stool while preparing meals. d. The patient sleeps with two pillows under the head.
D
The nurse is caring for a patient who is living with human immunodeficiency virus (HIV) and taking antiretroviral therapy (ART). Which information is most important for the nurse to address when planning care? a. The patient reports feeling "constantly tired." b. The patient reports having no side effects from the medications. c. The patient is unable to explain the effects of atorvastatin (Lipitor). d. The patient reports missing doses of tenofovir AF/emtricitabine (Descovy).
D
The nurse prepares to administer the following medications to a hospitalized patient with human immunodeficiency (HIV). Which medication is most important to administer at the scheduled time? a. Nystatin tablet b. Oral acyclovir (Zovirax) c. Aerosolized pentamidine (NebuPent) d. Oral tenofovir AF/emtricitabine/bictegravir (Biktarvy)
D
The nurse reviews the laboratory results of a patient who is receiving chemotherapy. Which laboratory result is most important to report to the health care provider? a. Hematocrit 30% b. Platelets 95,000/μL c. Hemoglobin 10 g/L d. White blood cells (WBC) 2700/μL
D
Which action should the nurse take before administering gentamicin (Garamycin) to a patient with acute osteomyelitis? a. Ask the patient about any nausea. b. Obtain the patient's oral temperature. c. Change the prescribed wet-to-dry dressings. d. Review the patient's serum creatinine results.
D
Calcium
Decreased serum level is found in osteomalacia, kidney disease and hypoparathyroidism. Increased level found in hyperparathyroidism, some bone tumors
Alkaline Phosphate
Enzyme needed to form bone. Elevated levels in healing fractures, bone cancers, osteoporosis, osteomalacia and paget's disease.
Clinical manifestations of Lupus
General: fever, weight loss, joint pain, excessive fatigue. Most commonly affects skin, muscles, lining of lungs, heart, nervous tissue, and kidneys. Range from mild disorder to rapidly progressive disease.
Probable causes of Lupus
Genetic, hormones (menses, birth control pill, pregnancy), Environmental (sun, UV light, stress, chemicals, toxins, infectious agents), drugs (procainamide, hydrazaline, quinidine)
HIV Pathophysiology
Immune problems start when CD4+ T cell counts drop less than 500 cells/uL. SEVERE PROBLEMS WHEN LESS THAN 200. (Normal is 800 to 1200).
Biological response modifiers
In RA slows progression. Used alone or in combo with DMARDs
Drug therapy for lupus
NSAIDS: for joint pain. risk for GI bleed. Antimalarial drugs: fatigue, skin and joint problems, reduce flares. Corticosteroids: used for severe cutaneous SLE. Immunosuppressive drugs: suppress immune system and decrease end-organ damage.
Manifestations of RA
Onset is subtle. Fatigue, anorexia, weight loss, generalized stiffness that becomes localized with progression. Specific joint involvement: pain, stiffness, limited motion, and signs of inflammation. Symptoms occur symmetrically. Often affects small joints. Morning stiffness
Methotrexate
Used to treat early RA. Side effects: bone marrow suppression and hepatotoxicity. Need to monitor CBC and blood chem. Therapeutic effects in 4-6 wks. May be given alone or w/ biologic response modifiers. Ed: re pregnancy.
Classification of Cancer
Tumors can be classified by anatomic site, histology (grading severity), or by the extent of the disease (staging) 0: cancer in situ. I: limited to tissue of origin, localized growth. II: limited local spread. III: extensive local and regional spread. IV: metastasis. TNM: tumor size and invasiveness (T), spread of lymph nodes (N), Metastasis (M)
Sulfasalazine and hydroxychloroquine
Used for mild to moderate disease. Works quicker. Drink fluids. Wear sunscreen. Eye exam for baseline then every 6 to 12 months.
Other problems with lupus
increased risk of infection. Pneumonia most common. NO LIVE VACCINES IF TREATED WITH CORTICOSTEROIDS OR CYTOTOXIC DRUGS. Pregnancy with lupus: increased risk of loss, IUGR.
Treatment goals for HIV
adherence with drug regimens, adopting healthy lifestyle, protecting others from HIV, beneficial relationships, explore spiritual issues, coping with the disease and its treatment. Preventing opportunistic infection.
Rheumatoid arthritis: Risk factors
affects all ethnic groups. Peaks between 30 and 50. Three times more likely in women. Combination of genetics and environmental factors. Smoking increases risk to patients genetically predisposed and may interfere with treatment. May report history of precipitating stressful event: infection, stress, exertion, childbirth, surgery, emotional upset.
causes of secondary immunodeficiency
age, diseases/disorders, drug induced, malnutrition, stress, therapies
Phosphorus
amount present is indirectly related to calcium metabolism. Decreased in osteomalacia. Increased found in kidney disease, healing fractures and osteolytic metestatic tumor
Common physical problems: HIV
anxiety, fear, depression, diarrhea, peripheral neuropathy, pain, nausea/vomiting, fatigue.
Rheumatoid factor
assess presence of autoantibody in serum. Not specific for rheumatoid arthristis and is seen in other connective diseases as well as small percentage of normal population.
Pathophysiology of Lupus
autoantibodies made against single and double stranded DNA, erythrocytes, coagulation proteins, lymphocytes, platelets and other proteins. Circulating immune complexes deposited in basement capillary membranes of kidneys, heart, skin, brain and joints- overaggressive autoimmune response and related activation of B and T cells.
Nondrug therapy for RA
balance of rest and activity, heat and cold application, relaxation techniques, joint protection. Alternate rest and activity. Avoid total bed rest. Modify activities to avoid overexertion. Splints. ROM exercises.
Rheumatoid Arthritis
chronic, systemic autoimmune disease. Inflammation of connective tissue in synovial joints. Periods of remission and exacerbation.
AIDS
criteria established by CDC. Severe immune compromise: infections, malignancies, wasting and HIV-related cognitive changes. Pneumocystis jiroveci pneumonia.
Treatment goals for cancer
cure, control, palliation
Diagnosis of RA
joint involvement, rheumatoid factor, elevated CRP and ESR, Duration of symptoms long term. Cloudy synovial fluid. Bone scans, xray, tissue biopsy.
Main goals for treatment of HIV
decrease viral load. Maintain and increase CD4 counts. Prevent HIV transmission.
Corticosteroid therapy in RA
decreases inflammation. Complications: weight gain. Low dose oral for limited time.
Nervous system problems of lupus
disordered thinking, disorientation, memory deficits, stroke, peripheral neuropathy, headache.
Graft vs Host disease
donor tissue rejects recipient tissue. Most common in stem cell recipients. 7-30 days post transplant. Difficult to treat once it starts. Attacks skin, liver, GI tract.
treatment of anaphylaxis
epinephrine: causes constriction of vascular system and stimulates the SNS. Given IM or IV. Beta blockers may make pt resistant to treatment. O2 should be administered at 100%!!
End of life care for HIV
focus on nursing interventions. Patient comfort. Facilitating emotional and spiritual needs. Helping significant others deal with loss, maintain safe environment.
Hematologic problems of lupus
formation of antibodies against blood cells. Anemia, leukopenia, thrombocytopenia, coagulation disorders- treat with warfarin
Acute exacerbation of HIV
has no cure. Continues for life. Causes physical disability. impairs social, emotional, economic ans spiritual well-being. Ultimately leads to death.
Genotype and phenotype assays
help health care proveder know which medications may be effective against HIV.
ART drug interactions
herbal therapies: especially St. John's wort. Commonly used OTC drugs: antacids, proton pump inhibitors, supplements.
Tacrolimus and Cyclosporine
immunosuppressive drugs used after organ transplant. GRAPEFRUIT ALERT- prevents metabolism and increases toxicity.
Causes of primary immunodeficiency
phagocytic defects, B-cell, T-cell, combined B & T cell.
Musculoskeletal problems of lupus
polyarthralgia with morning stiffness, arthritis, increased risk of bone loss and fracture.
PrEP
preexposure prophylaxis for HIV. Used to reduce risk of acquiring HIV infection in at risk person. Currently involves taking part of an HIV antiretroviral regimen daily. Used in conjunction with other proven protection interventions.
Which result for a patient with systemic lupus erythematosus (SLE) should the nurse identify as most important to communicate to the health care provider? a. Decreased C-reactive protein (CRP) b. Elevated blood urea nitrogen (BUN) c. Positive antinuclear antibodies (ANA) d. Positive lupus erythematosus cell prep
B
The nurse palpates enlarged cervical lymph nodes on a patient diagnosed with acute human immunodeficiency virus (HIV) infection. Which action would be appropriate for the nurse to take? a. Instruct the patient to apply ice to the neck. b. Tell the patient a secondary infection is present. c. Explain to the patient that this is an expected finding. d. Request that an antibiotic be prescribed for the patient.
C
Which patient who has arrived at the human immunodeficiency virus (HIV) clinic should the nurse assess first? a. Patient whose rapid HIV-antibody test is positive. b. Patient whose latest CD4+ count has dropped to 250/μL. c. Patient who has had 10 liquid stools in the last 24 hours. d. Patient who has nausea from prescribed antiretroviral drugs.
C
Nutritional therapy for RA
balanced nutrition. Pain, fatigue and depression lead to decreased appetite. Lower endurance and mobility can cause inability to shop and prepare food resulting in weight loss. Involve OT.
A patient being seen in the clinic has rheumatoid nodules on the elbows. Which action should the nurse take? a. Draw blood for rheumatoid factor analysis. b. Teach the patient about injections for the nodules. c. Assess the nodules for skin breakdown or infection. d. Discuss the need for surgical removal of the nodules.
c
FLEXERIL (cyclobenzaprine)
drowsiness,
A client takes medication for rheumatoid arthritis. The nurse reviews the client's list of medications and knows that which of the following medications is used to treat and manage rheumatoid arthritis
indomethacin
Renal problems of lupus
mild proteinuria to rapidly progressive glomerulonephritis. scarring can lead to end-stage renal disease. Goal is to slow progression of neuropathy and preserve renal function. Treatments: corticosteroids, cytotoxic agents, immunosuppressive agents. Renal failure is the leading cause of death for lupus pts.
Interprofessional care for HIV
monitor disease progression, immune function and manage symptoms. Initiate and monitor ART. Prevent, detect and or treat opportunistic infections.
HIV progression
monitored by CD4 (provides a marker of immune function) count and viral load (lower the viral load, less active the disease).
HIV accute infection
mononucleosis-like symptoms: fever, swollen lymph nodes, sore throat, headache, malaise, nausea, muscle and joint pain, diarrhea and/or a diffuse rash. Occurs about 2 to 4 weeks after infection. Highly infectious,
chronic rejection
months to years after. irreversible. unknown cause. S/Sx: fever, chills, body ache. Confirm with lab work for organ.
Screening for HIV
most useful screenings test for specific antibodies and/or antigens. May take several weeks to detect antibodies. Combination antigen-antibody tests can detect HIV earlier.
Systemic Lupus Erythematosus
multisystem inflammatory autoimmune disease. Complex disorder: genetic, hormonal, environmental and immunologic factors. Affects the skin, joints, serous membranes (pleura and pericardium), renal system, hematologic and neurologic systems. Unpredictable with alternating remission and worsening. More common in blacks, Asian Americans, Hispanics and native Americans. 90% are women 15 to 45.
Diagnosis of Lupus
no specific test. Involves H&P, antibodies: ANA is present in 97% of cases. CBC, serum complement, urinalysis, xrays of affected joints. EKG
Acute rejection
occurs in first 6 months. Lymphocytes act against donor- more likely in deceased donors.
hyperacute rejection
occurs within the first 24 hours. removal necesary
Overall treatment goals for RA
pain management, minimal loss of function, participate in therapeutic regimen, maintain positive self-image, perform self-care.
Delaying disease progression of HIV
promoting healthy immune system. Nutritional support, moderating or eliminating alcohol, tobacco, and drug use. Keeping up to date with vaccinations, getting adequate rest and exercise, avoiding exposure to infections agents, counseling and support groups.
Signs and symptoms of anaphylaxis
rapid, weak pulse, hypotension, dilated pupils, dyspnea
Surgical Therapy for RA
relieve severe pain. improve function. Synovectomy- removal of joint lining. Arthroplasty- total joint replacement.
Metabolic disorders r/t HIV
renal, cardiovascular disease, hyperlipidemia, insulin resistance, hyperglycemia, bone disease, lactic acidosis, lipodystrophy.
HIV: Other infections
shingles, persistent vaginal yeast infections, oral or genital herpes, bacterial infections, kaposi sarcoma. oral hairy leukoplakia.
Cardipulmonary complications of lupus
tachypnea, cough, pleurisy (inflammation of lung layers), dysrhythmias, pericarditis,
HLA matching
testing for organ donation compatibility1
NSAID treatment in RA
treat pain and inflammation. May take 2 to 3 weeks for full effect.
HIV complications: Oral thrush
treated with nystatin. Swish and swallow or swish and spit depending on severity. Very painful- don't want to eat or drink. Cold may soothe.
