NUR 211 Quiz 5

What are some clinical manifestations of systemic lupus erythematosus?

Butterfly rash on face (Malar rash) Scalp rashses and bald area Polyarthritis (inflammation of joint) - usually on non-erosive joint surfaces Hypertension, pericarditis, and dysrhythmias

What is the expected treatment for someone with sickle cell disease?

Hydroxurea - management for sickle cell disease. It increases fetal hemoglobin and decreases sickling of red blood cells. Adverse effect: bone marrow suppression and WBC, RBC, and Platelet inhibition. Morphine PCA pump - instruct patient not to let family push button. Monitor for respiratory depression and sedation. Non-pharmacological: Do NOT use hot & cold therapy. Cold causes vasoconstriction and increases the risk for sickling of cells. Heat can cause inflammation and increase burn injury risk. Can use light massage.

What drug is used for the maintenance of sickle cell disease? Hydroxyurea hydroxychloroquine Hydromorphone

Hydroxyurea Rationale: Hydroxyurea is used in the treatment of sickle cell disease. Rationale: Hydroxychloroquine is used in the treatment of Lupus. Rationale: Hydromorphone is used for pain management

What is a major cause of death in patients with SLE?

Infection is a major cause of death.

Risk factors of RA

Family history Smokers Obesity Physical, emotional trauma Exposure to pollution, insecticides, occupational exposures

Which of the following are systemic clinical manifestations of a client with lung cancer? (Select all that apply) Fever Anorexia Cough Hemoptysis Malaise

Fever, anorexia, malaise

A nurse is caring for a client who has osteoporosis and is taking a calcium supplement. When the client tells the nurse she has been having some flank pain, which of the following adverse effects should the nurse suspect? Renal stones Hepatitis Hip fracture Pancreatitis

Renal stones Rationale: Kidney (renal) stones is correct. Calcium supplements may cause renal stones. Clients should increase their water intake while taking calcium supplements to hydrate the kidneys and should report any blood in the urine or flank pain.

What are some clinical manifestations of RA?

Slow, insidious onset Joint deformities Boutonniere deformity of the thumb Swan-neck deformity of fingers Inflammation of eyes, lungs, heart, kidneys, GI tract Sjogren's syndrome: Dry mouth and eyes "hallmark" signs

Which client population has the highest incidence of non-smoking associated lung cancer? Asian Older adults Men Women

Women

Risk factors for hypersensitivity reactions:

Anyone is at risk. Repeated exposure Family history

Which diagnostic test for lung cancer is used to evaluate the size and location of tumor? Chest X-ray CT scan Bronchoscopy Ultrasound

CT Scan

What are some triggers for sickle cell crisis?

Dehydration, fever, stress, cold temperatures, illness, extreme exercise, infection, hypoxia, alcohol, tobacco use, pregnancy. Sometimes there are no triggers.

What are some local effects of lung cancer?

cough, dull ache in chest, hoarseness, dyspnea, dysphagia

Rheumatoid Arthritis (RA)

A chronic autoimmune disease causing inflammation of connective tissue.

What would a focused assessment look like for someone who is in a SCD crisis?

Respiratory assessment, check oral mucosa, level of consciousness, capillary refill, skin color/turgor, general appearance, pulses, monitor for shock, V.S., pain, visual acuity, extremities (examine for clots), psychosocial, monitor for signs and symptoms of stroke

Which nursing interventions are examples of primary prevention for lung cancer? (Select all that apply.) Tobacco control legislation Low-dose CT scan screening Health insurance incentives for "Not smoking" Testing homes for radon Referral to lung cancer support group

Tobacco control legislation Health insurance incentives for "Not smoking" Testing homes for radon

Treatment decisions for lung cancer are based on what factors?

Treatment decisions for lung cancer are based on location, type of cancer cell, stage of tumor, and the patient's ability to tolerate treatment.

What are some systemic effects of lung cancer?

weight loss, weakness, bone pain, fatigue, clubbing of fingers and toes due to long term effects of hypoxia, confusion, impaired gait and balance, headache

A nurse in a clinic is teaching a postmenopausal client about prevention of osteoporosis. Which of the following statements by the client requires clarification of the teaching? "I will avoid very high protein diets." "I will select foods which have high calcium content." "I will limit my intake of soft drinks." "I will include vitamin E rich foods in my diet."

"I will include vitamin E rich foods in my diet." Rationale: This statement needs clarification because vitamin E rich foods do not prevent osteoporosis.

What diagnostic tests can be done to confirm Lung cancer?

CT Scan - used to locate and evalute tumors Biopsy and cytologic examination Bronchoscopy - done to visualize and to obtain a biopsy specimen from the tumor. Early sputum specimen - done in the morning before eating.

Ways to decrease caregiver role strain for someone caring for an individual with SCD.

Determine the ability of the caregiver to administer medications and fluids to provide adequate nutrition. Assess caregiver's knowledge of signs of infection and sickle cell crisis and when to seek medical care. Refer parents for genetic counseling, especially if they plan on having more children. Provide referrals to support groups Provide resources, including information about respite care for parents and information as needed for siblings.

A Nurse is assessing a client who has systemic lupus erythematosus (SLE). Which of the following findings should the nurse expect? Facial rash Thickened skin Chronic back pain Iritis

Facial rash Rationale: SLE causes a characteristic facial "butterfly" rash that is dry, scaly, red, and raised

​A nurse is teaching a client who is about to start therapy with alendronate (Fosamax) to treat osteoporosis. Which of the following adverse effects should the nurse instruct the client to report? (Select all that apply.) Tinnitus ​Jaw pain ​Drowsiness ​Dysphagia

Jaw pain dysphagia Rationale: ​Tinnitus is incorrect. Alendronate is unlikely to cause tinnitus. Salicylate toxicity is a common cause of tinnitus.Jaw pain is correct. Alendronate can cause osteonecrosis of the jaw, so the client should report this effect to the provider. Alendronate can cause ocular inflammation, so the client should report vision problems to the provider.Drowsiness is incorrect. Alendronate is unlikely to cause drowsiness. It can, however, cause headache.Dysphagia is correct. Alendronate can cause esophagitis, so the client should report any difficulty or pain with swallowing.

What is a drug that is used to treat Lupus (and rheumatoid arthritis), and is a category X pregnancy risk?

Methotrexate

Nursing interventions for Comfort (managing pain) for individual with lung cancer:

Pain medications Nonpharmacologic therapy such as gentle massage Blankets Pillows

What are some examples of goals for the patient experiencing a hypersensitivity reaction?

Patient will avoid known substances that provoke hypersensitivity response. Patient will describe self-care to reduce symptoms of seasonal allergies. Patient will describe proper self-administration of medications by physician Patient participates in determining substances that cause hypersensitivity by keep an accurate food journal.

What is an example of a type 3 immune complex mediated hypersensitivity?

Rheumatoid arthritis and lupus

A nurse is teaching a client at high risk for osteoporosis about dietary measures she can take to increase her calcium level. The nurse should advise the client to increase her intake of: Carrots Spinach Cabbage Potatoes

Spinach Rationale: One cup of cooked spinach contains 200 mg of calcium. Most vegetables contain considerably less calcium, except for kale, collard greens with stems, and turnip greens, which are also good sources of calcium.

What are some patient goals for someone with lung cancer?

The patient will demonstrate an understanding of his diagnosis. The patient will demonstrate the ability to make informed decisions regarding future treatments. The patient will verbalize feelings and thoughts of concern in relation to diagnosis and treatment plan.

What goal is an example of patient-centered care?

The patient will verbalize feelings and thoughts of concern in relation to diagnosis and treatment plan.

What is an important factor in the quality of care received by older adults with lung cancer?

The timeliness in which care is received.

Risk factors for Rheumatoid arthritis:

Family history Smoker Obesity Physical, emotional trauma Exposure to pollution, insecticides, and occupational exposures

Nursing interventions for prevention of infection for individual with lung cancer:

Use soft toothbrushes Use electric razor rather than traditional razor Avoiding crowds and those who are sick

Non-pharmacological treatment of RA includes:

Rest and exercise Splinting inflamed joints reduces unwanted motion, provides joint rest. Physical therapy Balanced diet containing fish Drinking plenty of fluids

What is malaise?

Malaise is a general feeling of discomfort or illness.

Does a type 1 hypersensitivity reaction have a rapid onset or delayed?

Rapid onset

Upon arrival to the unit follow a SCD exacerbation, what is a priority nursing intervention?

Hydration - IV fluids to help those sickle cells return to normal shape. (think about fluffing a pillow) Oxygen Pain management Support

Nursing interventions for Mobility (managing fatigue and activity intolerance) for individual with lung cancer:

Keep personal items within easy reach Plan periods of rest between activities Teach measures to conserve energy while performing ADLS (slip of shoes, shower chair etc.)

What is an example of a Type 1 hypersensitivity reaction?

Poison plants Latex Animal dander Jewelry Milk Medication Nuts and shellfish Bee sting Pollen Dust Mold and mildew Can lead to anaphylactic shock and death.

A nurse is assessing a client who has systemic lupus erythematosus (SLE). Which of the following findings is the highest priority for the nurse to report to the provider? Client reports mild feelings of depression Dry, raised rash on the face. Presence of sudden peripheral edema. Joint pain in hands and knees.

Presence of sudden peripheral edema. Rationale: The client who has SLE is at greatest risk for death from lupus nephritis. Therefore, according to the safety and risk reduction priority setting framework, findings that indicate an impairment of renal function are the highest priority to report. Rationale: The client who has SLE commonly reports joint pain and rash. However, according to Rationale: The client who has SLE commonly reports feelings of depression. However, according to the safety and risk reduction priority setting framework, these other findings are not the highest priority.

What patient teaching should be provided to an individual being treated for lupus?

Disease and treatment Medications Signs of exacerbations and renal involvement Importance of using mild soap and shampoo Wearing warm socks and gloves for Raynaud's phenomenon Sesitivity to light

What is the expected pharmacologic treatment of rheumatoid arthritis?

Disease modifying anti-rheumatic drugs (DMARDS) Methotrexate NSAIDS (pain only) Hydroxychloroquine (plaquenil) Short term steroids - often used as a "bridge" while a drug is taking effect or during severe disease flare up. ***Monitor for infections, never stop taking medication abruptly, monitor glucose level, monitor I/Os.****

What is an example of a type 2 cytotoxic hypersensitivity reaction?

hemolytic transfusion reactions, drug-induced hemolytic anemia

What diagnostic testing is done to confirm Rheumatoid arthritis?

Look at history, Physical Exam, Lab findings RA factor ESR and CRP Anti-CCP (more specific) X-rays/CT Examination of synovial fluid

What are some nursing diagnoses for the individual experiencing a hypersensitivity reaction?

Ineffective Airway Clearance Decreased Cardiac Output Risk for injury Impaired spontaneous ventilation Risk for shock

Give one example of each: primary, secondary and tertiary prevention related to lung cancer.

Primary: Avoid smoking and teach others about the importance of smoking cessation Secondary: The next step is encouraging those over the age of 55 to get screened, especially if they have a family history or are showing signs and symptoms. Tertiary: Ensure the maintenance of the quality of life for the patient. At this point the patient has received the diagnosis and is going to be undergoing treatment (if they chose) so maintenance of their quality of life is going to be important.

What are risk factors for lung cancer

Smoking Working in a mill Age (over 55) Exposure to radon - working in caves/mines Exposure to ionizing radiation and inhaled irritants (asbestos)

A nurse is teaching with a client about taking high doses of oral glucocorticoids for an extended period of time to treat rheumatoid arthritis. Which of the following instructions should the nurse include in the teaching? "Plan to check blood glucose levels for hypoglycemia once yearly." "Glucocorticoids will boost immunity." "Limit the intake of calcium rich foods while taking the medication." "Monitor for compression fractures of the back and neck."

"Monitor for compression fractures of the back and neck." Rationale: High-dose, long-term use of glucocorticoids can result in bone loss in the back and neck Rationale: Clients who do not have diabetes mellitus should have blood glucose levels checked for hyperglycemia, not hypoglycemia, at least twice yearly, because of the medications effect glucose production and utilization.Rationale: Clients who are taking glucocorticoids may have increased susceptibility to infection due to the suppression of both the immune system and neutrophils production to fight infection. Rationale: Clients who are taking high-dose, long-term use of glucocorticoids decreases the intestinal absorption of calcium; therefore, calcium supplements with vitamin D are recommended.

A nurse is assessing a client who is taking hydroxychloroquine. The nurse should report which of the following adverse effects to the provider immediately? Blurry vision Diarrhea Fatigue Pruritus

Blurry Vision Rationale: When using the urgent vs non-urgent approach to client care, the nurse should determine that the priority finding to report to the provider is blurred vision, as this is a manifestation of hydroxychloroquine toxicity and can be an indication of retinal damage.

What are some nursing diagnoses for Rheumatoid arthritis?

Chronic pain Fatigue Ineffective role performance Disturbed body image Impaired physical mobility Anxiety Activity intolerance Self-care deficit

What are symptoms that a type 1 hypersensitivity reaction has occurred?

feeling of uneasiness/impending doom, anxiety, itching urticaria, angioedema, bronchoconstriction, mucosal edema, excess mucus production Respiratory symptoms: congestion, rhinorrhea, dyspnea, respiratory distress, wheezing, crackles, or decreased breath sounds, hoarseness, stridor, hypoxia Cardiac symptoms: hypotension, rapid weak irregular pulse, diaphoretic. Can lead to anaphylactic shock and death.

What are some labratory tests to test for SLE?

ANA - AntiNuclear antibody Anti DNA - specific to lupus

What are some adverse effects of cyclophosphamide and what is it used to treat?

Adverse effects: cytotoxic (toxic to living cells), immunosuppressive agent - more susceptible to infection, cardio toxic It is used to treat lupus

A nurse in a providers office is talking with a client about risk factors for osteoporosis. Which of the following factors should the nurse include? (select all that apply) Aging Caffeine intake Secondhand smoke Obesity Long term steroid use

Aging Caffeine intake Secondhand smoke Long term steroid use Rationale: Sedentary lifestyle is correct. Immobility depletes bone. Obesity is incorrect. Women who are obese have a greater capacity for storing estrogen to help maintain acceptable levels of calcium. Aging is correct. Women lose bone due to estrogen depletion after menopause. Caffeine intake is correct. Excessive caffeine intake causes calcium loss in the urine. Secondhand smoke is correct. Smoking is a risk factor for osteoporosis, both active and passive (secondhand) smoking. Long term steroid use is correct, this places the client at risk for bone demineralization with long term use.

Emergency care of anaphylaxis:

Assess airway, respiratory status, O2 saturation, vital signs, call for support team Administer epinephrine (subcutaneous) or IV if severe repeat as needed every 5-15 minutes until client responds Apply O2 via high flow non-rebreather mask at 100%, set up suction and may need intubation supplies Start an IV if the client does not have one Elevate the HOB 45 degrees or higher if blood pressure is stable- if hypotensive, elevate HOB to about 10 degrees. Raise feet and legs Stay with patient and reassure patient

A nurse is caring for a client who has a new diagnosis of systemic lupus erythematosus (SLE) and asks where this disease originates within the body. The nurse should tell the client that SLE originates in which of the following locations in the body? Connective tissue Muscle tissue Peripheral vascular system

Connective tissue Rationale: SLE originates in the connective tissues of the body and affects all organ systems.

What is an example of a type 4 Delayed hypersensitivity reaction?

Contact dermatitis, latex allergy

What is a type 2 hypersensitivity reaction?

Cytotoxic hypersensitivity

What is hydroxychloroquine (Plaquenil) used to treat? What is an adverse effect of hydroxychloroquine (Plaquenil)?

It is used to treat Lupus (and rheumatoid arthritis). Benefits should outweigh the risks. Adverse effect: Retinopathy, patient should have vision monitored every 6 months.

A nurse in a provider's office is assessing a client who has rheumatoid arthritis (RA). Which of the following findings is a late manifestation of this condition? Anorexia Knuckle deformity Low-grade fever

Knuckle deformity Rationale: Joint deformity is a late manifestation of RA.

A nurse is performing a physical examination of an older adult client who is postmenopausal and has a history of osteoporosis and a body mass index of 23. Which of the following spinal deformities should the nurse expect to find in this client? Lordosis Kyphosis Scoliosis Ankylosis

Kyphosis Rationale: Kyphosis, a forward "stooping" posture with a loss of height, is an angulation of the posterior curve of the thoracic spine, usually a result of osteoporosis. It is most common in older adults and increases with aging and vertebral fractures. Rationale: Scoliosis is a lateral curvature of the thoracic spine, most often in adolescents. Rationale: Ankylosis is an immobility and consolidation of a joint, often a result of a congenital disorder or scarring. Rationale: Lordosis or swayback is an exaggerated lumbar curve or anterior convexity of the lumbar spine that is common with obesity and pregnancy.

Which of the following tests is used to screen for lung cancer? MRI PET scan Low dose CT scan Chest X-ray

Low dose CT Scan

A nurse is reviewing laboratory values for a client who has systemic lupus erythematosus (SLE). Which of the following values should give the nurse the best indication of the client's renal function? Serum creatinine Blood urea nitrogen (BUN) Serum sodium Urine-specific gravity

Serum Creatinine Rationale:A renal function disorder reduces the excretion of creatinine, resulting in increased levels of blood creatinine. Creatinine is a specific and sensitive indicator of renal function. The BUN is used as a gross index of glomerular function and the production and excretion of urea. High-protein diets, rapid-protein catabolism, and dehydration are conditions that will cause an elevation in the BUN. This is not the best indication of the client's renal function.

A nurse in a clinic is caring for a client with suspected osteoporosis. Which of the following assessment findings is a risk factor for the development of the disease? ​Smokes 1 pack of cigarettes per day ​Drinks one alcoholic beverage per week ​Large body stature History of bone fracture during childhood

Smoking is correct Rationale: ​Current smoking is a risk factor for osteoporosis. Rationale: ​A history of low-trauma fracture after age 50 is a risk factor, not childhood fractures Rationale: ​Low body weight with a thin build is a risk factor, not large body stature. Rationale: ​High alcohol intake of 3 or more drinks a day is a risk factor, not low consumption

What are some adverse effect of Hydroxyurea?

Suppression of RBC, WBC, and Platelets. Bone marrow suppression

Treatment for lupus:

THERE IS NO CURE Remissions and exacerbations are commone Control STRESS LEVELS Rest medications exercise stress reduction proper nutrition :include oily fish Skin care - lotion, mild shampoos Avoid the sun - wear proper clothing, hats with brims, and sunscreen of at least 15 spf.

What are some potential complications of a sickle cell crisis?

Thrombosis and infarction, cardiovascular collapse, cerebral occlusion, Acute chest syndrome (common cause for hospitalization for SCD patients) , pulmonary infiltrate.

A nurse is talking with an older adult client who has osteoporosis about beginning a program of regular physical activity. Which of the following recommendations should the nurse make? High-impact aerobics Walking briskly and weight training Riding a bicycle Stretching and swimming exercises

Walking briskly and weight training Rationale: ​Weight-bearing exercises/weight training is CORRECT! they are essential for maintaining bone mass. Walking is an appropriate activity for an older client to promote weight bearing and to maintain bone mass. Rationale: ​Riding a bicycle provides no weight-bearing advantages. Rationale: ​Stretching and swimming exercises provide no weight-bearing advantages. Rationale: ​High-impact aerobics can injure bones that have lost density.

A nurse is teaching a female client who has a new diagnosis of systemic lupus erythematosus (SLE). The nurse should recognize the need for further teaching when the client identifies which of the following as a factor that can exacerbate SLE? Exercise Infection Pregnancy Sunlight

Exercise Rationale: Deconditioning and muscle atrophy occurs as a result of lack of mobility. The nurse should encourage client to engage in conditioning exercises alternated with periods of rest. Rationale:Exposure to sunlight and artificial ultraviolet light can cause for an exacerbation of SLE manifestations, especially the characteristic skin manifestations of lesions and butterfly rash. Rationale:Pregnancy can cause an exacerbation of SLE, probably due to hormonal changes. The client should be advised of the risks and must be monitored closely for effects on the renal and cardiovascular systems if she decides to get pregnant. Rationale:Infection is a major stressor on the body and can trigger an exacerbation of the SLE disease process. In addition, many clients who have SLE take steroid medications that place them at higher risk for infection.

What are some diagnostic tests for sickle cell diesease?

Initial testing in the U.S. is done on newborns. Obtain a heelstick and test for presence of HbS. Reticulocyte count: reticulocytes are immature red blood cells. Reticulocyte count would be elevated in sickle cell crisis.

What education about SCD should be provided to the patient and family ?

Provide information about treatment. For parents/caregivers: look for signs of dehydration such as dry mucous membranes, weight loss, & sunken fontanelles (in infants). Give specific instructions about how many ounces of liquid the child needs to drink each day. It is okay to use flavored popsicles and drinks to increase fluid intake in children. Provide patient/caregiver with careful instructions on infusion therapy and to monitor for signs of iron overload. Medical ID bracelet Current Vaccinations Provide ongoing support, refer to support groups. Encourage activity with appropriate periods of rest.

Nursing interventions for Oxygenation/ perfusion for individual with lung cancer:

Providing supplemental oxygen for comfort Teach the importance of cough and deep breathing exercises Provide incentive spirometer Percussion and postural drainage Teach the tripod position for optimal oxygen intake

A nurse is caring for a client who has streptococcal pneumonia and a prescription for penicillin G by intermittent IV bolus. 10 minutes into the infusion of the third dose, the client reports that the IV site itches and that he feels dizzy and short of breath. Which of the following actions should the nurse take first? Stop the infusion. Call the client's provider. Elevate the head of the bed Auscultate the client's breath sounds.

Stop the infusion Rationale: When using the airway, breathing, circulation approach to client care, the nurse should place the priority on stopping the infusion. The client is exhibiting signs of penicillin anaphylaxis and the first action that should be taken is to withdraw the medication. Rationale: The nurse should auscultate the client's breath sounds; however, another action is the priority. Rationale: The nurse should elevate the head of the bed; however, another action is the priority. Rationale: The nurse should call the client's provider; however, another action is the priority.

What is the main goal of treatment for RA?

To reduce pain and inflammation, preserve function, and to prevent deformity.

Types of hypersensitivity reactions:

Type 1 (IgE-mediated) hypersensitivity: localized or systemic reactions Type 2: Tissue specific reactions Type 3: Immune complex-mediated reactions Type 4: delayed reactions

A nurse is providing discharge teaching to a client who has systemic lupus erythematosus (SLE). Which of the following instructions should the nurse include? Avoid using moisturizing lotions on the skin Wash the hair with a mild protein shampoo. Apply powder liberally to sensitive skin areas. Use a sun-blocking agent with a sun protection of at least 15.

Use a sun-blocking agent with a sun protection of at least 15. Rationale: Clients who have SLE are prone to hair loss. They should use a mild protein shampoo and ... avoid treatments that can damage the hair and scalp, such as dyes and permanents. Clients who have SLE should not use powder or other drying skin products on their skin. Clients who have SLE should apply non-perfumed moisturizing lotions liberally to the skin