S3 U4 test questions 3

Your patient with rheumatoid arthritis (RA) is taking prednisone (Deltasone) and naproxen (Aleve) to reduce inflammation and joint pain. Which symptom is most important to communicate to the health care provider? 1. RA symptoms are worst in the morning 2. Dry eyes 3. Round and moveable nodules just under the skin 4. Dark-colored stools

4 Both naproxen (a nonsteroidal anti-inflammatory drug [NSAID]) and prednisone (a corticosteroid) can cause gastrointestinal bleeding, and the stool appearance indicates that blood may be present in the stool

The nurse is monitoring a preterm newborn for respiratory distress syndrome (RDS). Which finding in the newborn should alert the nurse to the possibility of this syndrome? 1. Tachypnea and retractions 2. Acrocyanosis and grunting 3. Hypotension and bradycardia 4. The presence of a barrel chest and acrocyanosis

1

The nurse is preparing to care for a newborn with respiratory distress syndrome. Which initial action should the nurse plan to best facilitate bonding between the newborn and the parents? 1. Encourage the parents to touch their newborn. 2. Identify specific caregiving tasks that may be assumed by the parents. 3. Explain the equipment that is used and how it functions to assist the newborn. 4. Give the parents pamphlets that will help them understand their newborn's condition.

1. Encourage the parents to touch their newborn.

A client has been newly diagnosed with systemic lupus erythematosus and is reviewing self-care measures with the nurse. Which statement by the client indicates a need to review the material? "I will avoid direct sunlight as much as possible." "Baby powder is good for the constant sweating." "Grouping errands will help prevent fatigue." "Rest time will have to become a priority."

"Baby powder is good for the constant sweating." Constant sweating is not a sign of SLE and powders are drying so they should not be used, at least not in excess. The client is correct in stating he/she should avoid direct sunlight, that grouping errands can prevent or reduce fatigue, and that rest will have to become a priority.

A client had an arthroscopy 1 hour ago on the left knee. The nurse finds the left lower leg to be pale and cool, with a 1+ pedal pulse. What action would the nurse perform first? Assess the neurovascular status of the right leg. Document the findings in the patient's chart. Elevate the left leg on at least two pillows. Notify the primary health care provider immediately.

Assess the neurovascular status of the right leg. The nurse would compare findings of the two legs as these findings may be normal for the client. If a difference is observed, the nurse would then notify the primary health care provider. Documentation would occur after the nurse has all the data. Elevating the left leg will not improve perfusion if there is a problem.

criteria for hospitalization for weight loss

Physical criteria for hospitalization include weight loss of more than 30% of body weight within 6 months, temperature below 36° C (hypothermia), heart rate less than 40 beats/min, and systolic blood pressure less than 70 mm Hg.

A client is being administered the first dose of belimumab for a systemic lupus erythematosus flare. What actions by the nurse are most appropriate? (Select all that apply.) Observe the client for at least 2 hours afterward. Instruct the client about the monthly infusion schedule. Inform the client not to drive or sign legal papers for 24 hours. Ensure emergency equipment is working and nearby. Make a follow-up appointment for a lipid panel in 2 months. Instruct the client to hold other medications for 72 hours.

Observe the client for at least 2 hours afterward. Ensure emergency equipment is working and nearby. This drug does not cause drowsiness, so there would be no restrictions on driving or signing legal documents. Elevated lipids are not associated with this drug. This drug is used in combination with other therapies, especially during a flare.

Tumor necrosis factor (TNF)

Secreted by macrophages and T cells to kill tumor cells and regulate immune responses and inflammation

what is pannus

The abnormal granulation tissue that leads to joint damage in rheumatoid arthritis is called pannus.

what is uveitis

Uveitis is inflammation of the​ uvea, the middle layer of the​ eye, and is a clinical manifestation of juvenile idiopathic arthritis.

The nurse is caring for a client recently diagnosed with rheumatoid arthritis​ (RA). The client​ states, "I always take care of​ myself, how could this happen to​ me?" Which response by the nurse is most appropriate regarding the​ client's risk for developing​ RA?​ a "RA occurs when there is a family history of the​ disease." b ​"RA occurs for clients who are​ underweight." c ​"RA occurs for clients with a history of using herbal​ remedies." d ​"RA occurs when there is a family history of coronary artery​ disease."

a

cachexia

a condition of physical wasting away due to the loss of weight and muscle mass anorexia

A client diagnosed with rheumatoid arthritis​ (RA) is being seen in an outpatient clinic. Which diagnostic test results would indicate presence of​ RA?​(Select all that​ apply.) a Increased erythrocyte sedimentation rate​ (ESR) b Decreased bone density c Positive​ anti-citrulline antibodies d Negative rheumatoid factor​ (RF) e Negative antinuclear antibodies

acd Increased ESR would indicate presence of inflammation in the​ joints, which occurs with rheumatoid arthritis. Rheumatoid arthritis may be present with a negative RF. A positive​ anti-citrulline antibody test indicates the presence of RA in the absence of RF.​Positive, not​ negative, antinuclear antibodies indicate presence of RA. Decreased bone density is found in clients with psoriatic​ arthritis, not with RA.

Which characteristics are risk factors for the development of rheumatoid​ arthritis?​(Select all that​ apply.) a Family history b Male sex c Genetic predisposition d Diet e Psychological stressors

ace

what eating disorder noramally has thin hair and amenorrhea

anorexia

Necrotizing enterocolitis (NEC) is an inflammatory disease of the gastrointestinal mucosa. The signs of NEC are nonspecific. Some generalized signs include: a. Hypertonia, tachycardia, and metabolic alkalosis. b. Abdominal distention, temperature instability, and grossly bloody stools. c. Hypertension, absence of apnea, and ruddy skin color. d. Scaphoid abdomen, no residual with feedings, and increased urinary output.

b Some generalized signs of NEC include decreased activity, hypotonia, pallor, recurrent apnea and bradycardia, decreased oxygen saturation values, respiratory distress, metabolic acidosis, oliguria, hypotension, decreased perfusion, temperature instability, cyanosis, abdominal distention, residual gastric aspirates, vomiting, grossly bloody stools, abdominal tenderness, and erythema of the abdominal wall. The infant may display hypotonia, bradycardia, and metabolic acidosis

A client has been receiving Rheumatrex (methotrexate) for severe RA. The nurse should tell the client to avoid: a. aspirin b. multivitamins c. omega 3 fish oils d. acetaminophen

b methotrexate is a folic acid antagonist. multi vitamins contain folic acid

hypoalbuminemia can cause what with anorexia

peripheral edema

The nurse is caring for Ms.​ Ruiz, a client recently diagnosed with rheumatoid arthritis. Ms. Ruiz is being seen by the primary care provider for a​ follow-up visit after a recent hospitalization. The nurse prepares to assess Ms. Ruiz. Which clinical manifestation found during the assessment process supports this​ client's diagnosis? a Morning stiffness that lasts for thirty minutes b Increased energy c Weight gain over the last several months​ d Low-grade fever

d Clients diagnosed with rheumatoid arthritis will often have a​ low-grade fever. This finding supports the​ client's diagnosis. Weight​ loss, morning stiffness that lasts more than one​ hour, and fatigue are other symptoms that support this diagnosis.

what will you need to monitor with prednisone and when should it be taken

glucose full stomach to enhance absorption for RA

body temp and BP in anorexia

hypothermia and hypotension

Belimumab (Benlysta) SLE

monoclonal antibody for treatment of systemic lupus erythematosus injection immunosupressant affects tumor necrosis factor used for flares

The nurse is caring for a client with RA. The nurse knows the clients early morning symptoms will be most improved by: a. taking a warm shower upon awakening b. applying ice packs to the joints c. taking two aspirin before going to bed d. going for a early morning walk

a

The nurse in a newborn nursery is monitoring a preterm newborn for respiratory distress syndrome. Which assessment findings should alert the nurse to the possibility of this syndrome? Select all that apply. 1. Cyanosis 2. Tachypnea 3. Hypotension 4. Retractions 5. Audible grunts 6. Presence of a barrel chest

1245

The nurse is preparing to administer exogenous surfactant to a premature infant who has respiratory distress syndrome. The nurse prepares to administer the medication by which route? 1. Intradermal 2. Intratracheal 3. Subcutaneous 4. Intramuscular

2

You assess a 24-year-old patient with RA who is considering using methotrexate (Rheumatrex) for treatment. Which patient information is most important to communicate to the health care provider? 1. The patient has many concerns about the safety of the drug. 2. The patient has been trying to get pregnant. 3. The patient takes a daily multivitamin tablet. 4. The patient says that she has taken methotrexate in the past.

2 Methotrexate is teratogenic and should not be used by patients who are pregnant. The physician will need to discuss the use of contraception during the time the patient is taking methotrexate.

A nurse caring for clients with systemic lupus erythematosus (SLE) plans care understanding the most common causes of death for these clients is which of the following? (Select all that apply.) Infection Cardiovascular impairment Vasculitis Chronic kidney disease Liver failure Blood dyscrasias

Cardiovascular impairment Chronic kidney disease Any and all organs and tissues may be affected in SLE but the most common causes of death in clients with SLE include cardiovascular impairment and chronic kidney disease.

The nurse is assessing a client for signs and symptoms of systemic lupus erythematosus (SLE). Which of the following would be consistent with this disorder? (Select all that apply.) Discoid rash on skin exposed to sunlight Urinalysis positive for casts and protein Painful, deformed small joints Pain on inspiration Thrombocytosis Serum positive for antinuclear antibodies (ANA)

Discoid rash on skin exposed to sunlight Urinalysis positive for casts and protein Pain on inspiration Serum positive for antinuclear antibodies (ANA) Nonerosive arthritis in peripheral joints can occur but does not lead to deformity. Thrombocytopenia is another sign.

In the assessment of a preterm infant, the nurse notices continued respiratory distress even though oxygen and ventilation have been provided. The nurse should suspect: a. Hypovolemia and/or shock. b. A nonneutral thermal environment. c. Central nervous system injury. d. Pending renal failure.

a

A clinic nurse is assessing a client with a history of rheumatoid arthritis. The nurse would anticipate which assessment​ finding? a Progressive joint stiffness and deformation b Intermittent joint​ pain, mostly in the great toe c Joint stiffness in the​ spine, hips, and knees d Multiple joints and organs​ affected, and may have high fever and rheumatoid rash

a

A premature infant with respiratory distress syndrome receives artificial surfactant. How would the nurse explain surfactant therapy to the parents? a. "Surfactant improves the ability of your baby's lungs to exchange oxygen and carbon dioxide." b. "The drug keeps your baby from requiring too much sedation." c. "Surfactant is used to reduce episodes of periodic apnea." d. "Your baby needs this medication to fight a possible respiratory tract infection."

a

A client with rheumatoid arthritis is beginning to develop flexion contractures of the knees. The nurse should tell the client to: ❍ A. Lie prone and let her feet hang over the mattress edge ❍ B. Lie supine, with her feet rotated inward ❍ C. Lie on her right side and point her toes downward ❍ D. Lie on her left side and allow her feet to remain in aneutral position

a Lying prone and allowing the feet to hang over the end of themattress will help prevent flexion contractures. The client should be told to do thisseveral times a day. Answers B, C, and D do not help prevent flexion contractures;therefore, they are incorrect.

Failure to Thrive (FTT)

a disorder of infancy and early childhood characterized by variable eating and inadequate gains in weight physical and developmental retardation of infants or children resulting from physical or emotional neglect

What diagnostic tests are used for rheumatoid​ arthritis?​(Select all that​ apply.) a Erythrocyte sedimentation rate​ (ESR) b Antinuclear antibody​ (ANA) test​ c C-reactive protein​ (CRP) d Kidney biopsy e Renal function test

a,c RATIONALE: Laboratory tests used to diagnose rheumatoid arthritis include​ C-reactive protein levels and erythrocyte sedimentation rate. The antinuclear antibody​ (ANA) test, renal function​ test, and kidney biopsy are diagnostic tests for systemic lupus​ erythematosus, not rheumatoid arthritis.

Risk factors associated with necrotizing enterocolitis (NEC) include (Select all that apply): a. Polycythemia. b. Anemia. c. Congenital heart disease. d. Bronchopulmonary dysphasia. e. Retinopathy.

abc Risk factors for NEC include asphyxia, respiratory distress syndrome, umbilical artery catheterization, exchange transfusion, early enteral feedings, patent ductus arteriosus, congenital heart disease, polycythemia, anemia, shock, and gastrointestinal infection.

The client was admitted to an inpatient unit for uncontrolled pain caused by rheumatoid arthritis​ (RA). Which ongoing problems will the client have in relation to the​ RA?​(Select all that​ apply.) a Ineffective role performance b Poor​ self-esteem c Fatigue d Weight gain e Chronic pain

abce

The​ nurse, working in an internal medicine​ practice, prepares to see a client diagnosed with rheumatoid arthritis on the last visit. The client is complaining of pain and discomfort in the hands and knees. Which treatments can be used to reduce the pain and discomfort that the client is​ experiencing?​(Select all that​ apply.) a Exercising b Taking corticosteroids c Taking NSAIDs d Increasing sun exposure e Eating a balanced diet

abce

A​ 43-year-old woman, recently diagnosed with​ RA, asks the nurse whether she might have concerns beyond the problems with her joints. The nurse informs her that RA may also​ involve:Select all that apply. a The cardiovascular system. b The exocrine system. c The respiratory system. d The reproductive system. e The hematologic system.

abce RA can result in pleural effusion​ (collection of fluid in the pleural​ space). Individuals with RA have an increased risk of developing coronary heart disease. RA is a systemic disease of connective tissue that can affect exocrine​ glands, resulting most frequently in dry eyes and mouth. Properly​ managed, rheumatoid arthritis is not considered to be a danger for pregnant women or their babies. Patients with RA may suffer from a variety of hematologic​ disorders, particularly anemia.

A nurse is working in an outpatient clinic is assessing a client who has rheumatoid arthritis (RA). The client reports increased joint tenderness and swelling. Which of the following findings should the nurse expect? (SELECT ALL THAT APPLY) a Recent influenza b. Decreased ROM c. Hypersalivation d. Increased BP e. Pain at rest

abe

A nurse is caring for a client who has rheumatoid arthritis, which of the following laboratory tests are used to diagnose this disease? SELECT ALL THAT APPLY A. Urinalysis B. ESR C. BUN D. ANA titer E. WBC count

bde

Infants of mothers with diabetes (IDMs) are at higher risk for developing: a. Anemia. b. Hyponatremia. c. Respiratory distress syndrome. d. Sepsis.

c IDMs are at risk for macrosomia, birth injury, perinatal asphyxia, respiratory distress syndrome, hypoglycemia, hypocalcemia, hypomagnesemia, cardiomyopathy, hyperbilirubinemia, and polycythemia. They are not at risk for anemia, hyponatremia, or sepsis.

Which independent nursing interventions are used to treat rheumatoid​ arthritis?​(Select all that​ apply.) a Arthrodesis to fuse cervical​ vertebrae, wrists, ankles b Promote a​ well-balanced diet c Alternate periods of activity and rest d Educate about​ low-impact aerobics e Avoid sun exposure

cde