Med Surge - UNIT 2 REVIEW QUESTIONS
A 25-year-old client taking hydroxychloroquine (Plaquenil) for rheumatoid arthritis reports difficulty seeing out of her left eye. Correct interpretation of this assessment finding indicates which of the following? 1. Development of a cataract. 2. Possible retinal degeneration. 3. Part of the disease process. 4. A coincidental occurrence.
2. Possible retinal degeneration. Rationale: Difficulty seeing out of one eye, when evaluated in conjunction with the client's medication therapy regimen, leads to the suspicion of possible retinal degeneration. The possibility of an irreversible retinal degeneration caused by deposits of hydroxychloroquine (Plaquenil) in the layers of the retina requires an ophthalmologic examination before therapy is begun and at 6-month intervals. Although cataracts may develop in young adults, they are less likely, and damage from the hydroxychloroquine is the most obvious at-risk factor. Eyesight is not affected by the disease process of rheumatoid arthritis.
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. Early morning stiffness. Rationale: 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.
The teaching plan for the client with rheumatoid arthritis includes rest promotion. Which of the following would the nurse expect to instruct the client to AVOID during rest periods? 1. Proper body alignment. 2. Elevating the part. 3. Prone lying positions. 4. Positions of flexion.
4. Positions of flexion. Rationale: Positions of flexion should be avoided to prevent loss of functional ability of affected joints. Proper body alignment during rest periods is encouraged to maintain correct muscle and joint placement. Lying in the prone position is encouraged to avoid further curvature of the spine and internal rotation of the shoulders.
Which factors should the nurse check in a patient before applying a compression bandage? Select all that apply. A. Distal pulses B. Capillary refill C. Serum protein levels D. Partial thromboplastin time E. Fluid and electrolyte balance
A. Distal pulses B. Capillary refill Rationale: Applying a compression bandage may compromise the patient's blood circulation. Therefore, the nurse should assess the distal pulses to evaluate blood circulation before and after applying a compression bandage.
A 38-year old woman has newly diagnosed multiple sclerosis and asks the nurse what is going to happen to her. What is the best response by the nurse? A: "You will have either periods of attacks and remissions or progression of nerve damage over time." B: "You need to plan for a continuous loss of movement, sensory functions, and mental capabilities." C: "You will most likely have a steady course of chronic progressive nerve damage that will change your personality." D: "It is common for people with MS to have an acute attack of weakness and then not to have any other symptoms for years."
Answer: A Rational: Most patients with MS have remissions and exacerbations of neurologic dysfunction or a relapsing-remitting initial course followed by progression with or without occasional relapses, minor remissions, and plateaus that progressively cause loss of motor, sensory, and cerebellar functions.
A patient with newly diagnosed MS has been hospitalized for evaluation and initial treatment of the disease. Following discharge teaching, the nurse realizes that additional instruction is needed when the patient says what? A: "It is important for me to avoid exposure to people with upper respiratory infections." B: "When I begin to feel better, I should stop taking the prednisone to prevent side effects." C: "I plan to use vitamin supplements and a high-protein diet to help manage my condition." D: "I must plan with my family ho we are going to manage my care if I become more incapacitated."
Answer: B Rational: Corticosteroids used in treating acute exacerbations of MS should not be abruptly stopped by the patient because adrenal insufficiency may result and prescribed tapering does should be followed.
Mitoxantrone is being considered as treatment for a patient with progressive-relapsing MS. The nurse explains that a disadvantage of this drug compared with other drugs used for MS is what? A: It must be given subcutaneously every day. B: It has a lifetime dose limit because of cardiac toxicity. C: It is an anticholinergic agent that causes urinary incontinence. D: It is an immunosuppressant agent that increases the risk for infection.
Answer: B Rational: Mitoxantrone cannot be used for more than 2 to 3 years because it is an antineoplastic drug that causes cardiac toxicity, leukemia, and infertility. It is monoclonal antibody given IV monthly when patient have inadequate responses to other drugs.
The nurse is assigned to care for a client admitted to the hospital with a diagnosis of systemic lupus erythematosus (SLE). The nurse reviews the health care provider's prescriptions. Which of the following medications would the nurse expect to be prescribed? A) Antibiotic B) Antidiarrheal C) Corticosteroid D) Opioid analgesic
Answer: C Rational: Treatment of SLE is based on the systems involved and symptoms. Treatment normally consists of anti-inflammatory drugs, corticosteroids, and immunosuppressants. The incorrect options are not standard components of medication therapy for this disorder.
The nurse explains to a patient newly diagnosed with MS that the diagnosis is made primarily by? A: spinal x-ray findings B: t-cell analysis of the blood C: analysis of cerebrospinal fluid D: history and clinical manifestations
Answer: D Rational: There is no specific diagnostic test for MS. Positive findings on MRI include evidence of at least two inflammatory demyelinating lesions in at least two different locations within the central nervous system.
Most common diagnostic test for SLE patients: A) BUN B) ANA C) U/A D) CBC
B) ANA
A patient reports periumbilical pain that increases after coughing and sneezing. The patient prefers to lie still with the right leg flexed. What condition does the nurse suspect? A1. Peritonitis B. Appendicitis C. Gastroenteritis D. Ulcerative colitis
B. Appendicitis Rationale: Periumbilical pain that increases with coughing and sneezing indicates appendicitis. In this condition, the patients prefer to lie still with the right leg flexed. Peritonitis is characterized by abdominal pain; patients tend to lie still and take shallow breaths. Gastroenteritis is the inflammation of mucosa of stomach and small intestine; it is characterized by diarrhea, vomiting, and abdominal cramping. Ulcerative colitis is a form of inflammatory bowel disease characterized by bloody diarrhea and abdominal pain.
A client is suspected of having systemic lupus erythematous. The nurse monitors the client, knowing that which of the following is one of the initial characteristic sign of systemic lupus erythematous? A) Subnormal temperature B) Elevated red blood cell count C) Rash on the face across the bridge of the nose and on the cheeks D) Weight gain
C) Rash on the face across the bridge of the nose and on the cheeks Rational: Skin lesions or rash on the face across the bridge of the nose and on the cheeks is an initial characteristic sign of systemic lupus erythematosus (SLE). Fever and weight loss may also occur. Anemia is most likely to occur later in SLE.
A patient with abdominal trauma is at risk for the development of hypovolemic shock. What assessment finding by the nurse would indicate that the patient is developing this condition? A. Respiratory rate of 16 B. Heart rate of 58 beats/minute C. Blood pressure of 80/42 mm Hg D. Decreased pulse pressure
C. Blood pressure of 80/42 mm Hg Rationale: Hypovolemic shock is a life-threatening condition that results from excessive bleeding and abdominal trauma. The assessment findings of a patient with hypovolemic shock are decreased blood pressure, rapid breathing, and increased heart rate and pulse pressure.
When managing a patient with suspected bacterial meningitis, what immediate actions should the nurse perform? Select all that apply. A. Wait and watch till the fever reduces and next signs appear. B. Wait for a confirmed diagnosis before starting antibiotics. C. Collect specimens for a culture to confirm the diagnosis. D. Administer a corticosteroid along with the first dose of antibiotics. E. Initiate antibiotic therapy without waiting for a confirmed diagnosis.
C. Collect specimens for a culture to confirm the diagnosis. D. Administer a corticosteroid along with the first dose of antibiotics. E. Initiate antibiotic therapy without waiting for a confirmed diagnosis. Rationale: Collecting specimens to confirm the diagnosis and administering corticosteroids and antibiotics are the measures that must be taken immediately, because bacterial meningitis is a medical emergency. Waiting and watching until the fever reduces and the next signs of meningitis appear and waiting for a confirmed diagnosis before starting antibiotics are not advisable, because they may aggravate the condition and may become life-threatening.
A nurse is designing a plan of care for a patient with a soft tissue injury and related inflammation as a result of a motor vehicle accident. Which nursing intervention should be included in the plan? A.Avoid compression bandages, because they may compromise circulation. B. Keep the injured extremity moving for proper blood circulation. C. Elevate the injured extremity above the level of the heart to reduce pain. D. Use hot fomentation to increase the circulation at the inflamed site during initial trauma care.
C. Elevate the injured extremity above the level of the heart to reduce pain. Rationale: An injured extremity may become engorged with blood. Elevation of the injured extremity above the level of the heart helps to reduce pain associated with swelling by increasing the venous and lymphatic return.
Which symptom will persist until the irritation and inflammation is completely resolved in meningitis? A. Fever B. Nausea C. Seizures D. Headache
D. Headache Rationale: Headaches can occur for months after a diagnosis of meningitis until the irritation and inflammation have completely resolved. Fever, nausea, and seizures may be resolved by symptomatic treatment even when the inflammation is still present.
The nurse is providing care to a patient with cholecystitis that is experiencing severe nausea and vomiting. The nurse should include what intervention? A. Encouraging exercise B. Assisting with ambulation C. Assisting with repositioning D. Providing oral care every two hours
D. Providing oral care every two hours Rationale: Patients with cholecystitis may have severe nausea and vomiting. Therefore, the nurse should give frequent oral care to the patient to avoid discomfort. Encouraging exercise, assisting with ambulation, and repositioning are not interventions that address the problem of severe nausea and vomiting.
The nurse assesses a patient for signs of meningeal irritation and observes for nuchal rigidity. What indicates the presence of this sign of meningeal irritation? A. Tonic spasms of the legs B. Curling in a fetal position C. Arching of the neck and back D. Resistance to flexion of the neck
D. Resistance to flexion of the neck Rationale: Nuchal rigidity is a clinical manifestation of meningitis. During assessment, the patient will resist passive flexion of the neck by the health care provider. Tonic spasms of the legs, curling in a fetal position, and arching of the neck and back are not related to meningeal irritation.
A patient is prescribed a tumor necrosis factor (TNF) blocking agent for the treatment of Crohn's disease. Before beginning treatment, the healthcare provider will confirm the results of which of these diagnostic tests? A. Stool culture B. C. D. TB skin test
D. TB skin test Rationale: Screen for a TB infection prior to starting anti-TNF therapy.
Etanercept (Enbrel) is prescribed for a patient with stage II rheumatoid arthritis. The nurse monitors the patient's laboratory results with the knowledge that a positive response to the drug is reflected by: A. decreased lymphocyte count. B. absence of Rh factor in the blood. C. increased serum immunoglobulin G. D. decreased C-reactive protein (CRP)
D. decreased C-reactive protein (CRP)
The nurse suggests that a patient recently diagnosed with rheumatoid arthritis (RA) plan to start each day with a. a warm bath followed by a short rest. b. a short routine of isometric exercises. c. active range-of-motion (ROM) exercises. d. stretching exercises to relieve joint stiffness.
a. a warm bath followed by a short rest. Rationale: Taking a warm shower or bath is recommended to relieve joint stiffness, which is worse in the morning. Isometric exercises would place stress on joints and would not be recommended. Stretching and ROM should be done later in the day, when joint stiffness is decreased.
A patient with rheumatoid arthritis (RA) complains to the clinic nurse about having chronically dry eyes. Which action by the nurse is most appropriate? a. Teach the patient about adverse effects of the RA medications. b. Suggest that the patient use over-the-counter (OTC) artificial tears. c. Reassure the patient that dry eyes are a common problem with RA. d. Ask the health care provider about discontinuing methotrexate (Rheumatrex) .
b. Suggest that the patient use over-the-counter (OTC) artificial tears. Rationale: The patient's dry eyes are consistent with Sjögren's syndrome, a common extraarticular manifestation of RA. Symptomatic therapy such as OTC eye drops is recommended. Dry eyes are not a side effect of methotrexate. Although dry eyes are common in RA, it is more helpful to offer a suggestion to relieve these symptoms than to offer reassurance. The dry eyes are not caused by RA treatment, but by the disease itself.
Which laboratory result will the nurse monitor to determine whether prednisone (Deltasone) has been effective for a 30-year-old patient with an acute exacerbation of rheumatoid arthritis? a. Blood glucose test b. Liver function tests c. C-reactive protein level d. Serum electrolyte levels
c. C-reactive protein level Rationale: C-reactive protein is a marker for inflammation, and a decrease would indicate that the corticosteroid therapy was effective. Blood glucose and serum electrolyte levels will also be monitored to check for side effects of prednisone. Liver function is not routinely monitored in patients receiving corticosteroids.
During assessment of a patient admitted to the hospital with an acute exacerbation of MS, what should the nurse expect to find? a: tremors, dysphasia, and ptosis b: bowel and bladder incontinence and loss of memory c: motor impairment, visual disturbances, and paresthesias d: excessive involuntary movements, hearing loss, and ataxia
c: motor impairment, visual disturbances, and paresthesias Rational: Motor, sensory, cerebellar, and emotional dysfunctions, including paresthesias as well as patchy blindness, blurred vision, pain radiating along the dermatome of the nerve, ataxia, and sever fatigue, are the most common manifestations of MS. Constipation and bladder dysfunctions, short-term memory loss, sexual dysfunction, anger, and depression or euphoria may also occur. Excessive involuntary movements and tremors are not seen in MS.
