Musculoskeletal Disorders and Blood Disorders

An 18 year-old An 18 year-old male is taking Hydroxyurea for treatment of sickle cell anemia. Which options below indicate this medication is working successfully? Select all that apply: A. The patient needs fewer blood transfusions B. The patient experiences diuresis C. The patient experiences an increase in fetal hemoglobin (Hbg F). D. The patient experiences a decrease in hemoglobin S.male is taking

A,C Rationale: This medications actually treats cancer, but it will help with SCA in that it will help create fetal hemoglobin hgb F (this helps decrease sickling episodes) and helps with anemia (decreasing the need for so many blood transfusions).

A nurse is taking a health assessment of a patient who complains of low grade fever, fatigue, joint pain, muscle pain, and photosensitivity. SLE is suspected , and the nurse would check for which of the following signs that also occurs with SLE? a)Red Butterfly rash across cheeks and nose b)Ascites c)Polycythemia d)Rhonchi

ANS: A A Red Butterfly rash across the cheeks and nose is a tell-tale sign of SLE. It is caused when immune-related cells in a patient's skin react to damage from UV light exposure (i.e., spending too much time in the sun). People with Lupus may have photosensitivity and get sunburned more easily.

Following instruction for a patient with newly diagnosed systemic lupus erythematosus (SLE), the nurse determines that teaching about the disease has been effective when the patient says: a) "I need to restrict my exposure to sunlight to prevent an acute onset of symptoms." b) "I can expect a temporary improvement in my symptoms if I become pregnant." c) "I should expect to have a low fever all the time with this disease." d)"I should try to ignore my symptoms as much as possible and have a positive outlook."

ANS: A Sun exposure is associated with SLE exacerbation, and patients should use sunscreen with an SPF of at least 15 and stay out of the sun between 11:00 AM and 3:00 PM. Low-grade fever may occur with an exacerbation but should not be expected all the time. A positive attitude may decrease the incidence of SLE exacerbations, but patients are taught to self-monitor for symptoms that might indicate changes in the disease process. Symptoms may worsen during pregnancy and especially during the postpartum period.

Which statement by a patient with systemic lupus erythematosus (SLE) indicates that the patient has understood 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 take birth control pills to keep from getting pregnant." d) "I should avoid aspirin or nonsteroidal antiinflammatory drugs."

ANS: B Severe skin reactions can occur in patients with SLE who are exposed to the sun. Patients should avoid fatigue by balancing exercise with rest periods as needed. Oral contraceptives can exacerbate lupus. Aspirin and nonsteroidal antiinflammatory drugs are used to treat the musculoskeletal manifestations of SLE.

A patient is prescribed ibuprofen 800 mg every 4 hours for the treatment of rheumatoid arthritis (RA). Which of these clinical manifestations should the healthcare provider anticipate observing if the patient is developing an adverse effect from the medication? Select that apply: 1.Positive occult blood test 2.Increased blood urea nitrogen (BUN) 3.Client report epigastric pain 4.Decreased serum albumin 5.Increased serum hematocrit

Answer: 1, 2, 3 Rationale: •A good place to start when assessing for medication adverse effects is to recall the medication's mechanism of action. •NSAIDs like ibuprofen inhibit COX-1 and COX-2. Inhibiting COX-1 and COX-2 results in decreased prostaglandins. •Pain is managed when COX-1 is inhibited. •COX-2 is sometimes referred to as "good COX" (while COX-1 is sometimes called "bad COX), because when COX-2 is inhibited, prostaglandins that serve important normal functions are impaired. Prostaglandins are needed for the integrity of the peptic mucosal lining and maintenance of renal perfusion. Epigastric pain (peptic ulcer), blood in the stool (bleeding ulcer), and increased BUN (decreased renal perfusion and increased reabsorption of blood from the GI tract) are all indications that the patient may be experiencing a bleeding peptic ulcer.

Which of the following clinical manifestations should the healthcare provider anticipate observing in a patient diagnosed with rheumatoid arthritis (RA)? Select all that apply: 1.Increase C-reactive protein (CRP) 2.Low-grade fever 3.Decreased synovial fluid 4.Ulnar deviation 5. Bone spurs noted on X-ray

Answer: 1, 2, 4 Rationale: Think about the differences between the two major types of arthritis: osteoarthritis (OA) and rheumatoid arthritis (RA), and how those differences affect clinical presentation. RA is an autoimmune disease, while OA is not. Inflammation is slight and localized in OA. RA has systemic effects, while OA does not. Clinical manifestations expected in RA include increased CRP (a general indication of inflammation), low-grade fever (a systemic manifestation), and ulnar deviation (caused by chronic synovial inflammation, weakened ligaments, and subsequent deformities).

Which patient below is presenting with signs and symptoms of rheumatoid arthritis? Select all that apply: 1.A 35 year old patient who has severe morning stiffness for 45 minutes. 2.A 45 year old male with crepitus in the right knee. 3.A 30 year old female with warm, red, soft joints on the hands and wrist. 4.A 40 year old male whose x-ray imaging results showed osteophytes formation and decreased joint space in the left knee.

Answer: 1, 3 Rationale: Options 1 and 3 (morning stiffness, warm, red, soft joints) are common findings in RA. However, options 2 and 4 (crepitus, osteophytes formation and decreased joint space) are found in OA.

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? 1."It is best I try to incorporate a moderate level of high impact exercises weekly into my routine, such as running and aerobics." 2."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." 3."It is important I perform range of motion exercises during joint flare-ups and incorporate low-impact exercises into my daily routine." 4."Physical exercise should be limited to only range of motion exercises to prevent further joint damage."

Answer: 2 Rationale: 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.

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 symptom of rheumatoid arthritis? Select all that apply: 1."Does the pain and stiffness tend to be the worst before bedtime?" 2."Are you experiencing fatigue and fever as well?" 3."Is your pain and stiffness symmetrical on the body?" 4."Is your pain and stiffness aggravated by extreme temperature changes?"

Answer: 2, 3 Rationale: 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. Therefore, if the right wrist is inflamed, painful, and stiff the left wrist will be as well. RA is NOT aggravated by extreme temperatures. This is found in osteoarthritis.

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.

Answer: 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 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.

Answer: 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. Pain relief is a high priority during the acute phase because pain is typically severe and interferes with the client's ability to function. Preserving joint function and preventing joint deformity are high priorities during the acute phase to promote an optimal level of functioning and reduce the risk of contractures.

The client enters the outpatient clinic and states to the triage nurse, "I think I have the flu. I'm so tired, I have no appetite, and everything hurts." The triage nurse assesses the client and finds a butterfly rash over the bridge of nose and on the cheeks. Which diagnosis does the nurse expect? A) Systemic lupus erythematosus B) Fibromyalgia C) Lyme disease D) Gout

Answer: A Rationale: The rash over the nose and cheeks is sometimes called a butterfly rash and is classic for the diagnosis of systemic lupus erythematosus (SLE), although not every client diagnosed with this disorder will have this rash. While fibromyalgia, Lyme's disease, and gout share some symptoms of SLE, they do not cause a rash over the nose and cheeks.

The nurse is reviewing a health care provider's prescriptions for a child with sickle cell anemia who was admitted to the hospital for the treatment of vaso-occlusive crisis. Which prescriptions documented in the child's record should the nurse question? Select all that apply. A. Restrict fluid intake B. Position for comfort C. Avoid strain on painful joints D. Apply nasal oxygen at 2 L/minute E. Provide a high-calorie, high-protein diet F. Give meperidine, 25mg intravenously, every 4 hours for pain

Answer: A and F Sickle cell anemia is one of a group of diseases termed hemoglobinopathies, in which hemoglobin A is partly or completely replaced by abnormal sickle hemoglobin S. It is caused by the inheritance of a gene for aa structurally abnormal portion of the hemoglobin chain. Hemoglobin S is sensitive to changes in the oxygen content of the red blood cell; insufficient oxygen causes the cells to assume a sickle shape, and the cells become rigid and clumped together, obstructing capillary blood flow. Oral and intravenous fluids are an important part of treatment. Meperidine is not recommended for a child with sickle cell disease because of the risk for normeperidine-induced seizures. Positioning for comfort, avoiding strain on painful joints, oxygen, and a high-calorie and high-protein diet are also important parts of the treatment plan.

A Client with SLE is being treated with immunosuppressant drugs and corticosteroids. Which precautions should the nurse provide this client? Select all that apply. A) Avoid large crowds. B) Don't get a flu shot. C) Use contraception to prevent pregnancy D) Refrain from taking aspirin or ibuprofen. E) Report signs of infection to the physician.

Answer: A, C, D, E Crowds may increase exposure to infection. Annual influenza vaccination is recommended but clients with significant immunosuppression should not receive live vaccines. Immunosuppressive drugs may increase the risk of birth defects. Aspirin or ibuprofen may increase the risk of bleeding. Chills, fever, sore throat, fatigue, or malaise should be reported.

A client with SLE is being treated with immunosuppressant drugs and corticosteroids. Which precautions should the nurse provide this client? Select all that apply. A) Avoid large crowds. B) Don't get a flu shot. C) Use contraception to prevent pregnancy D) Refrain from taking aspirin or ibuprofen. E) Report signs of infection to the physician.

Answer: A, C, D, E RATIONALE: Crowds may increase exposure to infection. Annual influenza vaccination is recommended but clients with significant immunosuppression should not receive live vaccines. Immunosuppressive drugs may increase the risk of birth defects. Aspirin or ibuprofen may increase the risk of bleeding. Chills, fever, sore throat, fatigue, or malaise should be reported.

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

Answer: A,C,E B- gout D-osteoporosis

The nurse is caring for a client who has been diagnosed with discoid lupus erythematosus. The nurse is collaborating with the client to set goals for the nursing plan of care. What is an appropriate goal for this client? A) Work through the stages of death and dying. B) Comply 100% of the time with a sun protection plan. C) Gain weight to within 10 pounds of normal for height. D) Report pain no higher than four on a scale of 1-10.

Answer: B Explanation: Discoid lupus erythematosus is an autoimmune disorder of the skin, so the client must protect against the sun to avoid skin cancers and other complications. It is not fatal, is not related to weight, and is rarely painful unless complications arise.

A nurse is caring for a client with systemic lupus erythematous (SLE) who is taking hydroxychloroquine (Plaquenil). The nurse understands that the primary concern with this drug is: A) Pulmonary fibrosis. B) Cushingoid effects. C) Retinal toxicity. D) Renal toxicity.

Answer: C RATIONALE: Hydroxychloroquine (Plaquenil) is an antimalarial drug used in SLE to reduce the frequency of acute episodes of SLE. The primary concern with Plaquenil is retinal toxicity and possible irreversible blindness. Cushingoid effects are a concern with corticosteroid therapy. Pulmonary fibrosis is a potential adverse effect of cyclophosphamide, not Plaquenil. Renal toxicity is not the primary concern with Plaquenil.

A 14 year-old female has sickle cell anemia. Which factors below can increase the patient's risk for developing sickle cell crisis? Select all that apply: A. Shellfish B. Infection C. Dehydration D. Hypoxia E. Low altitudes F. Hemorrhage G. Strenuous Exercise

Answer: B,C,D,F & G Rationale: Sickle cell crisis can occur when the body experiences low amounts of oxygen in the body (so think about something that increases the body's need for oxygen or affects how oxygen is being transported). Therefore, infection (especially respiratory infections), dehydration, hypoxia, HIGH (not low) altitudes, hemorrhage (blood loss), or strenuous exercise can lead to a sickle cell crisis.

A female client asks the nurse if there are any conditions that can exacerbate systemic lupus erythematosus (SLE). Which is the best nurse response? A) "Conditions that cause hypotension can often exacerbate SLE." B) "GI upset is often associated with SLE exacerbation." C) "Pregnancy is often associated with an SLE exacerbation." D) "Fever is a known trigger for an SLE exacerbation."

Answer: C Explanation: A) Pregnancy can be associated with an exacerbation of SLE due to the rise of estrogen levels. Hypotension, fever, and GI upset are not factors that risk exacerbation of SLE.

A clinic nurse instructs the mother of a child with sickle cell disease about the precipitating factors related to a pain crisis. Which of the following, if identified by the mother as e precipitating factor, indicates the need for further instructions? A. infection B. trauma C. fluid overload D. stress

Answer: C Pain crisis may be precipitated by infection, dehydration, hypoxia, trauma, or physical or emotional stress. THe mother of a child with sickle cell disease should encourage fluid intake of 1.5-2 times the daily requirement to prevent dehydration!

The nurse notes that the client has a low red blood cell count and anticipates which of the following subjective manifestations on assessment? 1.Chest pain 2.Nausea 3.Sore throat 4. Fatigue

Answer: D Fatigue would signify that the body's tissues are not receiving enough oxygenation. Sore throat is a sign of infection. Chest pain may indicate an impending myocardial infarction. Nausea is a symptom for many disease processes, but is not typical for anemia.

1.The clinic nurse instructs parents of a child with sickle cell anemia about the precipitating factors related to sickle cell crisis. Which, if identified by the parents as a precipitating factor, indicates the need for further instruction? A. Stress B. Trauma C. Infection D. Fluid Overload

Answer: D Sickle cell crises are acute exacerbations of the disease, which vary considerably in severity and frequency, these include vaso-occlusive crisis, splenic sequestration, hyper hemolytic crisis, and aplastic crisis. Sickle cell crisis may ne precipitated by infection, dehydration, hypoxia, trauma, or physical or emotional stress. The mother of a child with sickle cell disease should encourage fluid intake of 1 ½ to 2 times the daily requirement to prevent dehydration.

You're providing education to a patient with sickle cell anemia who is taking Hydroxyurea. You will make it priority to tell the patient to? A. Consume foods high in calcium and potassium B. Avoid sick people and maintain strict hand hygiene C. Take this medication with at least 8 oz of water D. Monitor your blood glucose level daily

B Rationale: This medication can lower the white blood cell count. Therefore, the nurse should make it priority to tell the patient to avoid infection by avoiding sick people and performing hand hygiene regularly.

The pathophysiology of SLE involves... a)Abnormal IgG complexes that cause inflammation b)Overproduction of collagen that affects internal organs c)The body producing various autoantibodies that attack parts of the cell nucleus d)Immunodeficiency caused by increased activity of T-cells and decreased activity of B-cells.

C In SLE, the body produces many autoantibodies that are directed against parts of the cell nucleus, particularly DNA. Antibody complexes form and enter the bloodstream getting deposited in blood vessel walls, organs and or tissues which causes inflammation.

A patient who is having a sickle cell crisis asks the nurse why the sickling causes such pain. The nurse explains that the pain of sickling is caused by A. Spasms of the blood cells as they change shape B. Deposition of sickled red cells in the bone marrow C. Tissue hypoxia caused by small blood vessel occlusion D. Infectious processes in organs affected by the sickling

C. Tissue hypoxia caused by small blood vessel occlusion Rationale: The pain associated with sickle cell crisis is caused by ischemia as the sickled cells occlude small blood vessels and capillaries.

Which of the following factors need(s) to be included in a teaching plan for a child with sickle cell anemia? Select all that apply. A. The child needs to be taken to a physician when sick. B. The parent should make sure the child sleeps in an air-conditioned room. C. Emotional stress should be avoided. D. It is important to keep the child well hydrated.

Rationale: ACD A is correct because the parent should seek medical attention for illness to prevent the child from going into a crisis. C is correct because Stress can cause a depressed immune system, making the child more susceptible to infection and crisis. Parents and children are advised to avoid stress. D is correct because drinking water promotes healthy blood flow & reduces the chance of RBCs sickling and sticking together.

The nurse is preparing a client with sickle cell anemia for discharge. What information should the nurse include in the teaching plan? Select all that apply. A. Drink plenty of fluids when outside in the hot weather B. Avoid being in high altitudes where less oxygen is available C. Be aware that since she is homozygous for HbS, she carries the sickle cell trait D. Know that pregnancy with sickle cell disease increases the risk of a crisis E. Avoid flying on commercial airlines

¡Answer: A, B, D The nurse should teach the client to drink plenty of fluids to avoid becoming dehydrated. The client should avoid being in high altitudes such as mountains above 5,000 feet, where less oxygen is available and may precipitate a sickle cell crisis. The nurse should alert young women with sickle cell anemia that pregnancy increases the risk of a crisis. People who are homozygous for HbS have sickle cell anemia; the heterozygous form is the sickle cell trait. A client with sickle cell anemia may fly on commercial airlines; the airplane is pressurized and has an adequate oxygen level