MEDSURG EXAM 1

Of the clients listed below, who is at risk for developing rheumatoid arthritis (RA)? Select all that apply. 1. Adults between the ages of 20 and 50 years. 2. Adults who have had an infectious disease with the Epstein-Barr virus. 3. Adults that are of the male gender. 4. Adults who possess the genetic link, specifically HLA-DR4. 5. Adults who also have osteoarthritis.

1, 2, 4 Rheumatoid arthritis (RA) affects women three times more often than men, between the ages of 20 and 55 years. Research has determined that RA occurs in clients who have had infectious disease, such as the Epstein-Barr virus.

On a visit to the clinic, a client reports the onset of early symptoms of rheumatoid arthritis. The nurse should conduct a focused assessment for: 1. Limited motion of joints. 2. Deformed joints of the hands. 3. Early morning stiffness. 4. Rheumatoid nodules.

3 Initially, most clients with early symptoms of rheumatoid arthritis complain of early morning stiffness or stiffness after sitting still for a while. Later symptoms of rheumatoid arthritis include limited joint range of motion; deformed joints, especially of the hand; and rheumatoid nodules.

A 25-year-old female is about to deliver a baby. The patient is HIV-positive and has been taking antiretroviral therapy during the pregnancy. What steps can be taken to help prevent transmitting the virus to the baby after birth? A. Substitute formula for breastfeeding. B. Administer antiretroviral treatment to the newborn for 2 weeks after birth. C. Avoid kissing and hugging the newborn. D. Stop taking antiretroviral therapy for 2 months postpartum.

A

An appropriate nursing diagnosis for clients who are taking NSAIDs and anticoagulants would be which of the following? A. Risk for injury related to prolonged bleeding time, inhibition of platelet aggregation, and increased risk of GI bleeding. B. Potential for injury related to GI toxicity and decrease in bleeding time. C. Altered protection related to GI bleeding and increasing platelet aggregation. D. Risk for injury related to thrombocytosis prolonged prothrombin time

A

The nurse is caring for a client with severe osteoarthritis. What will the nurse anticipate as the client's priority problem? A. Joint pain B. ADL dependence C. Risk for falls D. Muscle stiffness

A

Which HIV test can give the earliest test results? A. Nucleic Acid Test (NAT) B. Antibody HIV Test C. Combination HIV antigen/antibody test D. CD4 count

A

A patient with Systemic Lupus Erythematous (SLE) takes the medication Azathioprine. Which statement by the patient requires re-education? A. "I've made sure all my vaccines are up-to-date, and I'm getting the Shingles vaccine next week." B. "This medication can increase my chances for developing infection." C. "This medication is "steroid-sparing" meaning it may help lower the amount of steroids I may need to manage my lupus." D. "This medication lowers my immune system."

A Azathioprine is an immunosuppressant. Patients can have vaccines while taking this medication but NOT live vaccines...like shingles, MMR etc.

A client develops a facial rash and urticaria after receiving penicillin. Which laboratory value does the nurse expect to be elevated? a) IgE b) IgG c) IgA d) IgB

A Immunoglobulin E (IgE) is involved with an allergic reaction. IgA combines with antigens and activates the complement system. IgB coats the surface of B lymphocytes. IgG is the principal immunoglobulin formed in response to most infectious agents

total hip arthroplasty is scheduled for a client with degenerative joint disease of the left femoral head. following surgery, it is most important for the nurse to place the client's left lef in which position? A. abducted with toes pointing forward B. elevated on two pillows with knees flexed C. elevated on several pillows with ankle abducted D. abducted with ankle joint hyperextended

A the nurse will maintain abduction by placing a pillow between the legs. it is not appropriate to elevate the legs as the position does not provide protection for the leg from adducting.

When administering a blood transfusion to a client with multiple traumatic injuries, the nurse monitors closely for evidence of a transfusion reaction. Shortly after the transfusion begins, the client complains of chest pain, nausea, and itching and there is a rise in the client's temperature. The nurse stops the transfusion and notifies the physician. The nurse suspects which type of hypersensitivity reaction with a blood transfusion? a) Type II (cytolytic, cytotoxic) hypersensitivity reaction b) Type IV (cell-mediated, delayed) hypersensitivity reaction c) Type I (immediate, anaphylactic) hypersensitivity reaction d) Type III (immune complex) hypersensitivity reaction

A ABO (blood type) incompatibility, such as from an incompatible blood transfusion, is a type II hypersensitivity reaction. Transfusions of more than 100 ml of incompatible blood can cause severe and permanent renal damage, circulatory shock, and even death.

A patient with rheumatoid arthritis is experiencing sudden vision changes. Which medication found in the patient's medication list can cause retinal damage? A. Hydroxychloroquine (Plaquenil) B. Lefluomide (Arava) C. Sulfasalazine (Azulfidine) D. Methylprednisolone (Medrol)

A This medication is a DMARD and can cause retinal damage. Therefore, the patient should be monitored for vision changes.

Which assessment findings will the nurse expect for the client with early- stage rheumatoid arthritis? Select all that apply. A. Joint inflammation B. Subcutaneous nodules C. Severe weight loss D. Fatigue E. Thrombocytosis F. Anorexia

A, D, F

The nurse is caring for a client who is deficient in T cells. The nurse should anticipate that the cause of the T cell deficiency is related to which manifestation? Select all that apply. A. Decrease in leukocytes B. Decrease in monocytes C. Decrease in granulocytes D. Hypersensitivity reaction E. Impaired cellular immunity

A, E

A client had a left noncemented posterolateral total hip arthroplasty 2 days ago. Which statements will the nurse include in health teaching for the client? Select all that apply. A. "Practice leg exercises each day as instructed." B. "Take deep breaths and use incentive spirometry every 2 hours." C. "Be sure to cross your legs to be more comfortable in a chair." D. "Report sudden increased hip pain or rotation immediately to the nurse." E. "Stand on your right leg and pivot into the chair when geing out of bed."

A,B,D,E

You are providing education to a patient, who was recently diagnosed with rheumatoid arthritis, about physical exercise. Which statement made by the patient is correct? A. "It is best I try to incorporate a moderate level of high impact exercises weekly into my routine, such as running and aerobics." B. "I will be sure to rest joints that are experiencing a flare-up, but I will try to maintain a weekly regime of range of motion exercises along with walking and riding a stationary bike." C. "It is important I perform range of motion exercises during joint flare-ups and incorporate low-impact exercises into my daily routine." D. "Physical exercise should be limited to only range of motion exercises to prevent further joint damage."

B During flare-ups of RA the patient should rest the joint. However, it is important the patient performs range of motion exercises along with LOW-IMPACT exercise weekly (such as stationary bike riding, walking, water aerobics etc.). This will help with increasing the patient's energy level along with muscle strength and maintain joint health

You're assessing a patient's knowledge on how to use their EpiPen in case of an anaphylactic reaction. You're using an EpiPen trainer device to teach the patient. What demonstrated by the patient shows the patient knows how to administer the medication? Select all that apply: A. The patient injects the medication in the subq tissue of the abdomen. B. The patient massages the site after injection. C. The patient administers the injection through the clothes. D. The patient aspirates before injecting the medication.

B, C EpiPen is an auto-injector that is administered in the middle of outer thigh. It is not given in the abdomen. The patient should massage the site for 10 seconds after administration to increase absorption. It can be administered through clothes, if needed. Aspiration is not required for administration of this medication

You receive your patient back from radiology. The patient had an x-ray of the hips and knees for the evaluation of possible osteoarthritis. What findings would appear on the x-ray if osteoarthritis was present? Select-all-that-apply: A. Increased joint space B. Osteophytes C. Sclerosis of the bone D. Abnormal sites of hyaline cartilage

B, C The radiologist would be looking for osteophytes (bone spurs), sclerosis of the bone (abnormal hardening of the bones), and decreased joint space.

During a routine health check-up visit a patient states, "I've been experiencing severe pain and stiffness in my joints lately." As the nurse, you will ask the patient what questions to assess for other possible signs and symptoms of rheumatoid arthritis? Select-all-that-apply: "A. Does the pain and stiffness tend to be the worst before bedtime?" B. "Are you experiencing fatigue and fever as well?" C. "Is your pain and stiffness symmetrical on the body?" D. "Is your pain and stiffness aggravated by extreme temperature changes?"

B, C Patients with RA will experience pain and stiffness in the morning (for more than 30 minutes) not bedtime. It is common for patients to have a fever and be fatigued...remember RA affects the whole body not just the joints. It will also affect the same joints on the opposite side of the body.

Select all the risk factors for developing osteoarthritis: A. Malnutrition B. Obesity C. Manual labor jobs D. Premature birth E. Older age F. Diabetes

B, C, E

Do not give _____ if patient has a serious infection, TB, or MS because they may exacerbate these health problems.

BRM's

You're providing education to a Systemic Lupus Erythematosus support group about preventing flares. Which statement by a participant requires re-education about this topic? A. "Emotional stress and illness are triggers for a flare-up." B."I always wear large-brimmed hats and long sleeves when I'm outside." C. "Exercise should be avoided due to the physical stress it causes on the body." D. "I will make it priority to receive my yearly influenza vaccine.

C Remember LESS for less flares: Lower stress (avoid overworking, emotional, illness, and use techniques to have prevent stress), Exercise (helps joints and manages weight), Sleep (need more than 8 hours to prevent the body from getting too exhausted), Sun Protection (sunscreen and large-brimmed hats...sunlight can activate a flare).

The Human Immunodeficiency Virus (HIV) can NOT be spread in what type of fluid below? Select all that apply: A. Breastmilk B. Blood C. Tears D. Semen E. Vaginal Fluid F. Sweat

C, F

These drugs have more adverse effects than acetaminophen, with gastric toxicity and ulceration being the most common.

NSAIDs

Teach patients taking BRMs to avoid

getting live vaccines, crowds and people with infections (such as respiratory)

___________ affects the joints in a symmetrical fashion.

rheumatoid arthritis

A condition in which the patient has dry eyes (keratoconjunctivitis sicca [KCS], or the sicca syndrome), dry mouth (xerostomia), and dry vagina (in some cases). This health problem may occur as a separate condition or be associated with late-stage rheumatoid arthritis or other autoimmune arthritis-related disease.

sjogren's syndrome

explain Preoperative rehabilitation, or "prehab"

the patient and joint coach learn postoperative exercises, transfer and positioning techniques, and ambulation with a walker or crutches, depending on the patient's age and stability. It is essential to prevent functional decline after surgery and provide a quicker functional recovery

Corticosteroids are tapered because of the adverse effects that commonly occur with long- term therapy. This includes:

weight gain, fat redistribution (moon face; buffalo hump between the shoulders), increased risk for GI ulcers and bleeding, fragile skin that bruises easily, reduced muscle mass and strength, thinning scalp hair, increased facial and body hair, increased susceptibility to colds and other infections, and stretch marks.

Side effects with long-term corticosteroid therapy include:

weight gain, fat redistribution (moon face; buffalo hump between the shoulders), increased risk for GI ulcers and bleeding, fragile skin that bruises easily, reduced muscle mass and strength, thinning scalp hair, increased facial and body hair, increased susceptibility to colds and other infections, and stretch marks.

What is a normal CD4 count?

500-1500 cells/mm3

The Human Immunodeficiency Virus (HIV) mainly attacks what type of cells in the human body? A. Red Blood Cells B. CD4 positive cells C. Stem Cells D. Platelets

B

What enzyme is responsible for cutting long chains of virus to help prep the HIV for maturity? A. Integrase B. Protease C. Reverse transcriptase D. Kinase

B

Which medication below used to treat Systemic Lupus Erythematosus decreases inflammation quickly, is not for long-term usage, and can lead to weight gain, susceptibility to infection, diabetes, and osteoporosis? A. Hydroxychloroquine B. Prednisone C. Azathioprine D. Belimumab

B

You are assessing the diagnostic testing results for a patient that has rheumatoid arthritis. What result is NOT an indicator of this disease? A. Elevated erythrocyte sedimentation B. X-ray imaging showing osteophyte formation C. Positive c-reactive protein D. Positive rheumatoid factor

B

What is the BEST position for a patient in anaphylactic shock? A. Lateral recumbent B. Supine with legs elevated C. High Fowler's D. Semi-Fowler's

B This position will increase venous return to the heart, which will help increase cardiac output and blood pressure.

A patient with AIDS has dark purplish brown lesions on the mucus membranes of the mouth. As the nurse you know these lesions correlate with what type of opportunistic disease? A. Epstein-Barr Virus B. Herpes Simplex Virus C. Cytomegalovirus D. Kaposi's Sarcoma

D

How are the systemic type I IgE-mediated responses initiated? A. With contact of the allergen and IgE in the conjunctival tissues. B. by contact of the allergen with IgE in the bronchial tree C. the allergen makes contact with the IgE in the circulatory system D. Allergens are absorbed in the GI mucosa

D. Allergens are absorbed in the GI mucosa

Corticosteroids such as prednisone remain a common cornerstone of therapy for SLE.Common side effects that appear within a week of corticosteroid therapy include:

acne, sodium and fluid retention, hypertension, sensation of "nervousness," difficulty sleeping, and emotional changes such as crying easily

Immune modulators, also known as disease-modifying antirheumatic drugs (DMARDs) and cytotoxic agents, are used to control inflammation and suppress the overactive immune system when either corticosteroids are not effective or the patient cannot tolerate the dose needed. The three most commonly used drugs in this category are:

cyclophosphamide, methotrexate, and azathioprine

All ____ reduce protective immunity to some degree and increase the patient's risk for new infections and reactivation of dormant infections such as tuberculosis (TB)

immunosuppressants

Which medication would the patient be given with AIDS prior to meals that need appetite stimulation?

megestrol acetate

Which WBC is the first to respond where inflammation occurs?

nuetrophils

The nurse is assisting in planning care for a client with a diagnosis of immune deficiency. The nurse would incorporate which of the following as a priority in the plan of care? 1. Protecting the client from infection 2. Providing emotional support to decrease fear 3. Encouraging discussion about lifestyle changes 4. Identifying factors that decreased the immune function

1 The client with immune deficiency has inadequate or absent immune bodies and is at risk for infection. The priority nursing intervention would be to protect the client from infection.

The nurse prepares to give a bath and change the bed linens on a client with cutaneous Kaposi's sarcoma lesions. The lesions are open and draining a scant amount of serous fluid. Which of the following would the nurse incorporate in the plan during the bathing of this client? 1. Wearing gloves 2. Wearing a gown and gloves 3. Wearing a gown, gloves, and a mask 4. Wearing a gown and gloves to change the bed linens and gloves only for the bath

2 Gowns and gloves are required if the nurse anticipates contact with soiled items, such as wound drainage, or while caring for a client who is incontinent. Masks are not required unless droplet or airborne precautions are necessary. Regardless of the amount of wound drainage, a gown and gloves must be worn.

A client is in the acute phase of rheumatoid arthritis. Which of the following should the nurse identify as lowest priority in the plan of care? 1. Relieving pain. 2. Preserving joint function. 3. Maintaining usual ways of accomplishing tasks. 4. Preventing joint deformity.

3 Maintaining usual ways of accomplishing tasks would be the lowest priority during the acute phase. Rather, the focus is on developing less stressful ways of accomplishing routine tasks. P

A client with possible osteoarthritis is scheduled for a synovial fluid analysis. The nurse should explain to the client that this diagnostic test is being completed for which​ reason? A. To rule out inflammatory arthritis and gout B. To identify irregular joint space narrowing C. To evaluate for increased density of subchondral bone D. To determine the extent of joint damage

A Joint fluid analysis is used to detect​ inflammation, bacteria, and uric acid crystals to rule out inflammatory arthritis and gout. This test will not provide information on the extent of the joint damage.

A patient with severe rheumatoid arthritis is scheduled for a procedure called an arthrodesis. The nursing student you are precepting asks what type of procedure this is. Your response is: A. "It is a procedure where the affected joint is removed and each end of the bones found within that joint are fused together." B. "It is a procedure that involves replacing the joint with an artificial one." C. "It is a procedure where the surgeon goes in with a scope and cleans out the affected joint." D. "It is a procedure where the synovium is completely removed within the joint, which helps decrease inflammation of the joint.

A An arthrodesis (also called joint fusion) is where the affected joint is removed and the bones within it are fused together.

A patient is prescribed Belimumab for treatment of lupus. The patient has been taking the medication for one month. Which finding below during a patient assessment requires further evaluation? A. The patient reports trouble sleeping and loss of energy. B. The patient declines a flu shot via the intranasal route. C. The patient says they have not noticed a change in symptoms. D. The patient administers the medication in the subcutaneous tissue on the abdomen.

A Depression and suicide are serious side effects of this medication. Option A demonstrates the patient may be experiencing depression and further evaluation is needed.

As a well-rounded health care provider. you know that corticosteroid therapy is indicated in all of the following conditions except: A. Osteoarthritis B. Rheumatoid arthritis C. Systemic lupus erythematosus D. Acute spinal cord injury

A It has an inflammatory component but the disease is not severe enough to suppress the immune system. Lupus. spinal injury. and rheumatoid arthritis are conditions that require suppression of the immune system in order for the client to survive.

You're explaining to a group of outpatients about the signs and symptoms that may present with osteoarthritis. Select all the signs and symptoms that may present with this condition: A. Herberden's Node B. Morning stiffness for less than 30 minutes C. Soft, tender, warm joints D. Fever E. Anemia F. Hard and bony joints G. Crepitus H. Bouchard's Node

A, B, F, G, H

Which patient below is presenting with signs and symptoms of rheumatoid arthritis? Select all that apply: A. A 35 year old patient who has severe morning stiffness for 45 minutes. B. A 45 year old male with crepitus in the right knee. C. A 30 year old female with warm, red, soft joints on the hands and wrist. D. A 40 year old male whose x-ray imaging results showed osteophytes formation and decreased joint space in the left knee.

A, C

Which patients below are at risk for developing osteoarthritis? Select-all-that-apply: A. A 65 year old male with a BMI of 35. B. A 59 year old female with a history of taking long term doses of corticosteroids. C. A 55 year old male with a history of repeated right knee injuries. D. A 60 year old female with high uric acid levels.

A, C

Which statements are true about the pathogenesis of Systemic Lupus Erythematosus? Select all that apply: A. The phagocytosis process is not occurring properly, which causes the nuclear material inside the dying cell to be seen as a foreign invader and antinuclear antibodies are created. B. During cell death the nucleus of the cell fails to condense, which leads to the development of autoantibodies. C. Immune complexes form and attach within the structures of important organs, joints, and tissues, and this causes inflammation. D. Neutrophil activity is decreased and this causes B-cells to attack phagocytes and nuclear material within the cells, which leads to the activation of the complement cascade system and inflammation.

A, C

Which statements below are INCORRECT about Systemic Lupus Erythematosus? Select all that apply: A. Lupus mainly affects Black, Asian, and Hispanic men. B. Lupus is a chronic condition that has periods of flare-ups and remission. C. The joints and skin are rarely affected in lupus. D. Systemic Lupus Erythematosus (SLE) is the most common form of lupus.

A, C lupus mainly affects Black, Asian, and Hispanic WOMEN (not men). Option C is wrong because lupus DOES affect the joints and skin along with many other systems of the body (heart, lungs, kidneys, blood system, brain etc.).

A patient with osteoarthritis is describing their signs and symptoms. Which signs and symptoms below are NOT associated with osteoarthritis? Select-all-that-apply: A. Morning stiffness greater than 30 minutes B. Experiencing grating during joint movement C. Fever and Anemia D. Symmetrical joint involvement E. Pain and stiffness tends to be worst at the end of the day

A, C, D In OA: morning stiffness is LESS than 30 minutes, it is NOT systemic as RA (so fever and anemia will not be present), and it is asymmetrical (both joints are not involved). Pain and stiffness will actually be worst at the end of the day compared to the beginning due to overuse of the joints

A physician suspects a patient may have rheumatoid arthritis due to the patient's presenting symptoms. What diagnostic testing can be ordered to help a physician diagnose rheumatoid arthritis? Select all that apply: A. Rheumatoid factor B. Uric acid level C. Erythrocyte sedimentation D. Dexa-Scan E. X-ray imaging

A, C, E

A nurse is assigned a client with an acute exacerbation of rheumatoid arthritis (RA). Which medical facts about RA are essential in developing a plan of care? Select all that apply. a) The client experiences stiff, swollen joints bilaterally. b) The client may not exercise once the disease is diagnosed. c) Onset is acute and usually occurs between ages 20 and 40. d) Erythrocyte sedimentation rate (ESR) is elevated, and x-rays show erosions and decalcification of involved joints. e) The first-line treatment is gold salts and methotrexate. f) Inflamed cartilage triggers complement activation, which stimulates the release of additional inflammatory mediators.

A, D , F Elevated ESR and x-ray evidence of bony destruction are indicative of severe involvement. RA starts insidiously, with fatigue, persistent low-grade fever, anorexia, and vague skeletal symptoms, usually in middle age between the ages 35 and 50 years. Maintaining the ROM by a prescribed exercise program is essential, but clients must rest between activities. Salicylates and nonsteroidal anti-inflammatory drugs are considered the first-line treatments.

Which surgical treatment should the nurse anticipate may be offered to clients with osteoarthritis who cannot be managed with traditional​ treatment? (Select all that​ apply.) A. Arthroplasty B. Serum hyaluronic acid C. Joint fusion D. Cortisone therapy E. Osteotomy

A,C,E

During a head-to-toe assessment of a patient with osteoarthritis, you note bony outgrowths on the distal interphalangeal joints. You document these findings as: A. Bouchard's Nodes B. Heberden's Nodes C. Neurofibromatosis D. Dermatofibromas

B

The nurse cares for the client with a 10 year history of osteoarthritis. Which assessment does the nurse expect to find? A. upper and lower extremity joints warm to the touch and reddened in appearance B. increased joint pain and stiffness after periods of activity C. weight loss and decreased appetite D. increased erythrocyte sedimentation rate

B joint pain in OA is precipitated by activity and relieved by rest.

A nurse encourages a client with an immunologic disorder to eat a nutritionally balanced diet to promote optimal immunologic function. Which snacks have the greatest probability of stimulating autoimmunity? a) Applesause and dried apricots b) Potato chips and chocolate milk shakes c) Raisins and carrot sticks d) Fruit salad and mineral water

B A diet containing excessive fat, such as that found in potato chips and milk shakes, seems to contribute to autoimmunity — overreaction of the body against constituents of its own tissues.

You're providing education to a patient with AIDS on how to prevent opportunistic infections. Which statement below requires the nurse to re-educate the patient about this topic? A. "I'm traveling to Puerto Rico next week and will be sure to pack bottled water." B. "I've switched to buying raw organic milk." C. "Last month I received the Pneumovax." D. "My neighbor bought a cat last week."

B Patients with AIDS should AVOID raw, undercooked, and unpasteurized foods and beverages. These items could contain organisms that could cause serious infections to a person with a compromised immune system.

A patient is diagnosed with Systemic Lupus Erythematous (SLE). You note the patient has a red rash that starts on the nose and expands onto the cheeks of the face. This is known as what type of rash? A. Discoid B. Malar C. Miliaria D. Eczema

B means "butterfly rash"

You're providing care to a patient with severe rheumatoid arthritis. While performing the head-to-toe nursing assessment, you note the patient's overall skin color to be pale and the patient looks exhausted. You ask the patient how she is feeling, and she says "I'm so tired. I can't even get out of this bed without getting short of breath." Which finding on the patient's morning lab work may confirm a complication that can be experienced with rheumatoid arthritis? A. Potassium 3.2 mEq/L B. Hemoglobin 7 g/dL C. Sodium 135 mEq/L D. WBC count 6,500

B Patients with RA can experience anemia. A hemoglobin level can be helpful in diagnosing anemia (a normal level in females is 12 to 15.5 g/dL). The patient's signs and symptoms above are classic findings in anemia.

Which statement is FALSE concerning rheumatoid arthritis?* A. Rheumatoid arthritis most commonly affects the fingers and wrist. B. Rheumatoid arthritis is different from osteoarthritis in that it doesn't affect other systems of the body. C. Rheumatoid arthritis can occur at any age (20-60 year old most commonly). D. Ankylosis can occur in severe cases of rheumatoid arthritis.

B it does affect other systems in the body, which is why RA can present with fever and anemia

Which specific information will the nurse teach to the client with systemic lupus erythematosus newly prescribed belimumab therapy? A. Avoid injecting it in a site near a cutaneous lesion. B. The drug can only be given by a health care professional. C. Do not chew, crush, or split the tablet containing this drug. D. The drug must be taken at bedtime because it causes extreme drowsiness.

B monoclonal antibodies used to control SLE are usually given IV or SQ. Infusion-related reactions/ hypersensitivity reactions are possible, so the drug must be given by a healthcare professional so that an anaphylactic reaction can be managed. Patient monitoring during infusion and up to two hours afterward is required.

A 30-year-old patient is in the Acute Stage of HIV. What findings below correlate with this stage of HIV? Select all that apply: A. CD4 level <500 cells/mm3 B. No present of Opportunistic Infections C. High viral load D. Patient reports flu-like symptoms E. Patient is asymptomatic

B, C, D The patient's viral load is very HIGH during this time, but the CD4 count should be greater than 500 cells/mm3. Therefore, NO opportunistic infections are present during this time (the CD4 count is high enough to fight off these types of infections/diseases). In addition, the patient may report flu-like symptoms (aches, joint pain, headache, fever, fatigue, sore throat, swollen lymph nodes, GI upset, and rash).

After performing a physical​ assessment, the nurse suspects that a client is experiencing manifestations of osteoarthritis​ (OA). Which finding supports the​ nurse's suspicion?​ (Select all that​ apply.) A. Leg tremors B. Joint tenderness C. Reduced joint flexibility D. Crepitation E. Joint stiffness

B, C, D, E Manifestations of OA include crackling​ sounds, or​ crepitation, with joint​ movement; joint stiffness and​ tenderness; and reduced joint flexibility. Leg tremors can be associated with multiple sclerosis or Parkinson disease.

A patient with osteoarthritis has finished their first physical therapy session. As the nurse you want to evaluate the patient's understanding of the type of exercises they should be performing regularly at home as self-management. Select all the appropriate types of exercise stated by the patient: A. Jogging B. Water aerobics C. Weight Lifting D. Tennis E. Walking

B, C, E The patient wants to perform exercises that are low impact like: walking, water aerobics, stationary bike riding along with strengthen training (lifting weights: helps strengthen muscles around the joint), ROM: improves the mobility of the joint and decreases stiffness. It is important patients with OA avoid high impact exercises that will increase stress on weight bearing joints such as running/jogging, jump rope, tennis, or any type of exercise with both feet off the ground.

The nurse is assessing a client who has late-stage rheumatoid arthritis. Which assessment findings would the nurse expect for this client? Select all that apply. A. Joint inflammation B. Severe weight loss C. Bony nodules D. Joint deformities E. SjÖgren syndrome

B, D, E

During anaphylactic shock the mast cells and basophils release large amounts of histamine. What effects does histamine have on the body during anaphylactic shock? Select all that apply: A. Decreases capillary permeability B. Vasodilation of vessels C. Decreases heart rate D. Shifts intravascular fluid to interstitial space E. Constricts the airways F. Stimulates contraction of GI smooth muscles G. Inhibits the production of gastric secretions H. Itching

B, D, E, F, H Histamine: INCREASES capillary permeability (not decreases) by shifting the intravascular fluid to the interstitial space...this causes swelling and lowers blood pressure, vasodilates vessels...this lower blood pressure and causes red skin, increases heart rate (not decreases), constricts the airway...this causes difficulty breathing and wheezes, stimulates contraction of GI smooth muscles and stimulates (not inhibits) the production of gastric secretions...this leads to vomiting, nausea, and pain, and there is also itching.

Disease-modifying antirheumatic drugs (DMARDS) are used to treat rheumatoid arthritis. Select-all-the drugs below that are DMARDS: A. Dexamethasone (Decadron) B. Hydroxychloroquine (Plaquenil) C. Teriparatide (Forteo) D. Calcitonin E. Leflunomide (Arava) F. Methotrexate (Trexall)

B, E, F

The primary health care provider prescribes daily celecoxib for a client experiencing persistent joint pain in both knees. Which health teaching will the nurse provide for the client regarding this drug for long-term pain control? Select all that apply. A. "Take the prescribed drug before breakfast each day." B. "Report any sign of bleeding, including bloody or dark, tarry stool." C. "Do not take other NSAIDs while on celecoxib." D. "Report any major changes in the amount of urine you excrete each day." E. "Follow up with lab tests to assess liver function."

B,C,D

A patient with Systemic Lupus Erythematosus is experiencing a complication called Lupus Nephritis. What are some signs and symptoms that correlate with this complication of SLE? Select all that apply: A. Decreased Creatinine B. Increased BUN C. 48 hour urinary output of 720 mL D. Proteinuria E. Weight loss F. Edema in upper and lower extremities

B,C,D,F Lupus nephritis is a serious complication of SLE. It is a condition that affects the functional units of the kidneys called the nephrons. In severe cases, renal failure develops which leads to an INCREASED BUN/Creatinine, low UOP (<30 mL/hr), proteinuria, weightGAIN, and swelling in the upper and lower extremities.

A patient is undergoing testing for the evaluation of Systemic Lupus Erythematous. What lab findings below are associated with this condition? Select all that apply: A. Decreased ESR and CRP B. Positive ANA C. Positive Anti-dsDNA D. Negative Anti-Sm E. Low C3 and C4

B,C,E

A patient with Systemic Lupus Erythematosus is prescribed Hydroxychloroquine. Select all the educational points you will include in the patient's education about this medication: A. Hydroxychloroquine is considered a Biologic medication. B. It is used long-term to help prevent flares. C. This medication doesn't produce results immediately. Therefore, the patient may not see results for a couple of months. D. This medication binds with a protein that supports the activity of B-cells, which decreases the activity of B-cells. E. The patient must have their eyes checked regularly to monitor the retina while taking this medication.

B,C,E

Which action will the nurse perform first for a client in anaphylaxis to prevent harm? A. Applying oxygen by nonrebreather mask B. Administering IV diphenhydramine C. Injecting epinephrine D. Initiating IV access

C

Which statement below best describes the role of reverse transcriptase? A. It's an enzyme that helps cut up the long protein chains of HIV. B. It plays a key role in the maturity of the virus. C. Reverse transcriptase is an enzyme that turns viral RNA into viral DNA. D. Reverse transcriptase is an enzyme that allows the viral DNA to become part of the cell's DNA.

C

A 26-year-old female with Systemic Lupus Erythematosus has been hospitalized with a flare-up. The patient is now recovered and is about to be discharged. The patient expresses that she wants to have a baby soon. How long should the woman be advised to be in remission of this condition before trying to conceive a baby? A. 2 months B. 2 years C. 6 months D. 1 year

C Women with lupus, who want to become pregnant, need to make sure their lupus has been in control (hence remission....no flare-ups) for at least 6 months before conceiving. This is because there is a risk of miscarriage and clotting issues. Pregnancy and the post-partum period can cause flares.

Identify the correct sequence in how rheumatoid arthritis develops: A. Development of pannus, synovitis, ankylosis B. Anklyosis, development of pannus, synovitis C. Synovitis, development of pannus, anklyosis D. Synovitis, anklyosis, development of pannus

C The body attacks (specifically the WBCs) the synovium of the joint. The synovium becomes inflamed and this process is called synovitis. The inflammation of the synovium leads to thickening and the formation of a pannus, which is a layer of vascular fibrous tissue. The pannus will grow so large it will damage the bone and cartilage within the joint. The space in between the joints will disappear and anklyosis will develop, which is the fusion of the bone.

which new onset condition or symptom in a client who has SLE, now taking hydroxychloroquine, does the nurse deem to have the highest priority to prevent harm to the client? A. Increased bruising B. Increased daily output of slightly foamy urine C. Failure to see letters in the middle of a word D. Sensation of nausea within an hour of taking the drug

C a major complication of this drug is the toxicity to retinal cells, which can lead to permanent vision loss

A patient is newly diagnosed with osteoarthritis. Which medication below is NOT ordered to treat this condition? A. NSAIDs B. Intra-articular corticosteroids C. DMARDs D. Glucosamine

C you don't need immunosuppressant drugs for osteoarthritis

Your patient is having a sudden and severe anaphylactic reaction to a medication. You immediately stop the medication and call a rapid response. The patient's blood pressure is 80/52, heart rate 120, and oxygen saturation 87%. Audible wheezing is noted along with facial redness and swelling. As the nurse you know that the first initial treatment for this patient's condition is? A. IV Diphenhydramine B. IV Normal Saline Bolus C. IM Epinephrine D. Nebulized Albuterol

C IM or subq Epinephrine is the first-line treatment for anaphylaxis. Epinephrine will cause vasoconstriction (this will increase the blood pressure and decrease swelling) and bronchodilation (this will dilate the airways). This patient's cardiovascular and respiratory system is compromised. Therefore, epinephrine will provide fast relief with anaphylaxis.

A patient newly diagnosed with osteoarthritis asks about the medication treatments for their condition. Which medication is NOT typically prescribed for OA? A. NSAIDs B. Topical Creams C. Oral corticosteroids D. Acetaminophen (Tylenol)

C Remember OA in within the joint...not systemic so oral corticosteroids are not as effective. All the other medications listed are prescribed in OA.

A nurse practicing in a nurse-managed clinic suspects that an 8-year-old child's chronic sinusitis and upper respiratory tract infections may result from allergies. Which laboratory test would the nurse most likely order? Select all that apply. a) Metabolic panel b) Rheumatoid factor c) Immunoglobulin assay (IgE) d) Liver function studies e) Complete blood count

C, E The nurse would order a complete blood count, which may indicate elevate white blood cells and eosinophils, as well as an immunoglobulin assay to look specifically for IgE elevations.

The nurse is caring for a client newly diagnosed with human immunodeficiency virus (HIV) obtained from unprotected sex. The nurse is in the room when the client is explaining the disease to another person. Which statement by the client would the nurse clarify? Select all that apply. a) "I will have this for the rest of my life." b) "The disease can also be spread by body fluids." c) "I am afraid that I will give this disease to my nephew." d) "I could pass this on to a baby before I give birth." e) "My sexual practices will have to change." f) "Medications can cure the disease."

C, F Human immunodeficiency virus (HIV) is a sexually transmitted infection. Casual contact such as that with a family member will not spread the disease.Unfortunately, at this time, there is no cure for the disease. The client is correct in stating that sexual practices will have to change to prevent further spread of the disease, the disease can be spread by body fluids and can also be passed on to a fetus.

The nurse is caring for a client who had an anterior total hip arthroplasty yesterday. For which commonly occurring postoperative complication will the nurse monitor for this client? A. Pneumonia B. Paralytic ileus C. Wound dehiscence D. Venous thromboembolism

D

The patient is prescribed to take Enfuvirtide (Fuzeon). The nurse prepares to administer this medication via? A. Intravenous route B. Oral route C. Topical Route D. Subcutaneous Route

D

During a head-to-toe assessment of a patient with arthritis, you note bony outgrowths on the proximal interphalangeal joint. These outgrowths are known as __________ and occur in ______________. A. Heberden's Node, osteoarthritis B. Bouchard's Node, rheumatoid arthritis C. Heberden's Node, rheumatoid arthritis D. Bouchard's Node, osteoarthritis

D Bouchard's Node are bony outgrowths on the proximal interphalangeal joint (middle joint of the finger and occur in osteoarthritis). Heberden's Node occur on the distal interphalangeal joint (finger joint closet to the fingernail).

The nurse is planning care for a client with human immunodeficiency virus (HIV). Which statement by the nurse indicates understanding of HIV transmission? Select all that apply. a) "I will wear a gown, mask, and gloves with all client contact." b) "I don't need to wear any personal protective equipment due to decreased risk of occupational exposure." c) "I will wear a mask if the client has a cough caused by an upper respiratory infection." d) "I will wear a mask, gown, and gloves when splashing bodily fluids is likely." e) "I will wash my hands after client care."

E, D Standard precautions include wearing gloves for any known or anticipated contact with blood, body fluids, tissue, mucous membranes, and nonintact skin.The nurse should wash hands before and after client care and after removing gloves. A gown, mask, and gloves are not necessary for all client care unless contact with bodily fluids, tissue, mucous membranes, and nonintact skin is expected.

True or False: Rheumatoid arthritis tends to affect women more than men and people who are over the age of 60

F Yes, RA tends to affect women more than men BUT it can affect all ages...most commonly 20-60 years old

Which of these takes its part in allergic and hypersensitive reactions?

IgE

Which immunoglobulin comes as the first produced in response to bacterial and viral infections?

IgM

Be sure that the patient is adequately hydrated when administering ____ to prevent acute renal failure.

NSAIDs

Risk factors for ____ adverse effects include being older than 60 years or having a history of peptic ulcer or cardiovascular (CV) disease.

NSAIDs

You're providing education to a patient, who has a severe peanut allergy, on how to recognize the signs and symptoms of anaphylactic shock. Select all the signs and symptoms associated with anaphylactic shock: A. Hyperglycemia B. Difficulty speaking C. Feeling dizzy D. Hypertension E. Dyspnea F. Itchy G. Vomiting and Nausea H. Fever I. Slow heart rate

Remember histamine affects the respiratory, cardiac, GI and skin. The patient can have the following: Respiratory: dyspnea and wheezing (bronchoconstriction), swelling of upper airways due to edema "tightness"...can't speak, coughing, stuffy nose, watery eyes, Cardiac: tachycardia, hypotension (vasodilation)...loss of consciousness, dizzy, GI: vomiting, nausea, pain, Skin: vasodilation...red, swollen, itchy, hives

Orlando who has been taking steroids for rheumatoid arthritis over several years presents with a compression vertebral fracture. This fracture is due to: A. An entirely separate condition. B. The osteoporotic effect of long-term steroid use. C. Deterioration in rheumatoid arthritis. D. An excessively high dose of steroids

The osteoporotic effect of long-term steroid use.

May be unilateral, single joint Affects weight-bearing joints and hands, spine Metacarpophalangeal joints spared Nonsystemic

osteoarthritis

Normal or slightly elevated ESR is a sign of which condition:

osteoarthritis

If the patient has a joint replacement for the first time, it is referred to as ________. If the implant loosens or fails for any reason, _______ may be performed to replace the previous one.

primary arthroplasty; revision arthroplasty