NCLEX Qs 280 Exam 3: RA, Lupus, MG, GBS, ALS

Which of the following statements should the nurse include in the teaching session when preparing a client for arthrocentesis? Select all that apply. 1. "A local anesthetic agent may be injected into the joint site for your comfort." 2. "A syringe and needle will be used to withdraw fluid from your joint." 3. "The procedure, although not painful, will provide immediate relief." 4. "We'll want you to keep your joint active after the procedure to increase blood flow." 5. "You will need to wear a compression bandage for several days after the procedure."

1, 2, 5. An arthrocentesis is performed to aspirate excess synovial fluid, pus, or blood from a joint cavity to relieve pain or to diagnosis inflammatory diseases such as rheumatoid arthritis. A local agent may be used to decrease the pain of the needle insertion through the skin and into the joint cavity. Aspiration of the fluid into the syringe can be very painful because of the size and inflammation of the joint. Usually a steroid medication is injected locally to alleviate the inflammation; a compression bandage is applied to help decrease swelling; and the client is asked to rest the joint for up to 24 hours afterwards to help relieve the pain and promote rest to the inflamed joint. The client may experience pain during this time until the inflammation begins to resolve and swelling decreases.

The home health nurse is doing a follow-up visit to a patient with recently diagnosed rheumatoid arthritis (RA). Which assessment made by the nurse indicates that more patient teaching is needed? 1- The patient sleeps with two pillows under the head. 2- The patient has been taking 16 aspirins daily. 3- The patient requires a 2 hour midday nap. 4- The patient sits on a stool when preparing meals.

1- The patient sleeps with two pillows under the head. Rationale: The joints should be maintained in an extended position to avoid contractures, so patients should use a small, flat pillow for sleeping. The other information is appropriate for a patient with RA and indicates that teaching has been effective. Cognitive Level: Application Text Reference: pp. 1708-1709

When helping a patient with rheumatoid arthritis (RA) plan a daily routine, the nurse informs the patient that it is most helpful to start the day with 1- a warm bath followed by a short rest. 2- a 10-minute routine of isometric exercises. 3- stretching exercises to relieve joint stiffness. 4- active range-of-motion (ROM) exercise

1- 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.

The client with myasthenia gravis is undergoing plasmapheresis at the bedside. Which assessment data warrant immediate intervention? 1. The client's BP is 94/60 and AP is 112. 2. Negative Chvostek's and Trousseau's signs. 3. The serum potassium level is 3.5 mEq/L. 4. Ecchymosis at the vascular site access.

1. The client's BP is 94/60 and AP is 112. 1. Hypovolemia is a complication of plasmapheresis, especially during the procedure, when up to 15% of the blood volume is in the cell separator. 2. Positive Chvostek's and Trousseau's signs (not negative signs) warrant intervention and indicate hypocalcemia, which is a complication of plasmapheresis. 3. This is a normal serum potassium level (3.5 to 5.5 mEq/L), which does not warrant intervention, but the level should be monitored because Plasmapheresis could cause hypokalemia. 4. Ecchymosis (bruising) does not warrant immediate intervention. Signs of infiltration or infection warrant immediate intervention.

After teaching the client with severe rheumatoid arthritis about prescribed methotrexate (Rheumatrex), which of the following statements indicates the need for further teaching? 1. "I will take my vitamins while I'm on this drug." 2. "I must not drink any alcohol while I'm taking this drug." 3. "I should brush my teeth after every meal." 4. "I will continue taking my birth control pills."

1. "I will take my vitamins while I'm on this drug." Because some over-the-counter vitamin supplements contain folic acid, the client should avoid self-medication with vitamins while taking methotrexate, a folic acid antagonist. Because methotrexate is hepatotoxic, the client should avoid the intake of alcohol, which could increase the risk for hepatotoxicity. Methotrexate can cause bone marrow depression, placing the client at risk for infection. Therefore, meticulous mouth care is essential to minimize the risk of infection. Contraception should be used during methotrexate therapy and for 8 weeks after the therapy has been discontinued because of its effect on mitosis. Methotrexate is considered teratogenic.

Which assessment intervention should the nurse implement specifically for the diagnosis of Guillain-Barré syndrome? 1. Assess deep tendon reflexes. 2. Complete a Glasgow Coma Scale. 3. Check for Babinski's reflex. 4. Take the client's vital signs.

1. Assess deep tendon reflexes. Hyporeflexia of the lower extremities is the classic clinical manifestation of this syndrome. Therefore, assessing deep tendon reflexes is appropriate. 2. A Glasgow Coma Scale is used for clients with potential neurological deficits and used to monitor for increased intracranial pressure. 3. Babinski's reflex evaluates central nervous system neurological status, which is not affected with this syndrome. 4. Vital signs are a part of any admission assessment but are not a specific assessment intervention for this syndrome

The client is diagnosed with MG. Which intervention should the nurse implement when administering the anticholinesterase pyridostigmine (Mestinon)? 1. Assess for excess salivation and abdominal cramps. 2. Administer the medication before the client has eaten. 3. Break the capsule and sprinkle the medication on the food. 4. Assess the client's potassium level prior to administering medication.

1. Assess for excess salivation and abdominal cramps. Anticholinesterase medications can cause the client to have excessive salivation and abdominal cramping. When this occurs, the client receives the antidote atropine simultaneously in small doses. Mestinon is administered with milk and/or crackers to prevent stomach upset. Mestinon does not affect potassium levels.

The nurse is preparing an educational program on amyotrophic lateral sclerosis (ALS). The nurse recognizes that this information is most appropriately presented at a: 1. Men's "50 or older" bowling league banquet. 2. Mother-and-daughter softball league season kickoff brunch. 3. "Singles over 60" wellness health fair. 4. A teenage men's hockey team annual fund raising event.

1. Men's "50 or older" bowling league banquet. Rationale: The onset of ALS typically occurs between 40 and 60 years of age, affecting men more often than women. While it can affect younger and older people of either gender, the 50-or-older male group would be the target population of the available options.

The health care provider plans to prescribe methotrexate (Rheumatrex) to a patient with newly diagnosed rheumatoid arthritis (RA). The patient tells the nurse, "That drug has too many side effects; I would rather wait until my joint problems are worse before beginning any drugs." The most appropriate response by the nurse is 1- "You should tell the doctor how you feel so the two of you can make a decision together." 2- "It is important to start methotrexate early in order to decrease the joint damage." 3- "Methotrexate is not expensive and will be cheaper to take than other possible drugs." 4- "Methotrexate is very effective and has no more side effects than the other available drugs.

2- "It is important to start methotrexate early in order to decrease the joint damage." Rationale: Disease-modifying anti-rheumatic drugs (DMARDs) are prescribed early to prevent the joint degeneration that occurs as soon as the first year with RA. The other statements are accurate, but the most important point for the patient to understand is that it is important to start DMARDs as quickly as possible.

When teaching range-of-motion exercises to a patient who is having an acute exacerbation of rheumatoid arthritis (RA) with joint pain and swelling in both hands, the nurse teaches the patient that 1- affected joints should not be exercised when pain is present. 2- cold applications before exercise will decrease joint pain. 3- exercises should be performed passively by someone other than the patient. 4- regular walking may substitute for range-of-motion (ROM) exercises on some days.

2- cold applications before exercise will decrease joint pain. Rationale: Cold application is helpful in reducing pain during periods of exacerbation of RA. Because the joint pain is chronic, patients are instructed to exercise even when joints are painful. ROM exercises are intended to strengthen joints as well as improve flexibility, so passive ROM alone is not sufficient. Recreational exercise is encouraged but is not a replacement for ROM exercises.

Which statement by the client supports the diagnosis of Guillain-Barré syndrome? 1. "I just returned from a short trip to Japan." 2. "I had a really bad cold just a few weeks ago." 3. "I think one of the people I work with had this." 4. "I have been taking some herbs for more than a year."

2. "I had a really bad cold just a few weeks ago." This syndrome is usually preceded by a respiratory or gastrointestinal infection one (1) to four (4) weeks prior to the onset of neurological deficits. 1. Visiting a foreign country is not a risk factor for contracting this syndrome. 3. This syndrome is not a contagious or a communicable disease. 4. Taking herbs is not a risk factor for developing Guillain-Barré syndrome

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. 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. 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 client with rheumatoid arthritis tells the nurse, "I have a friend who took gold shots and had a wonderful response. Why didn't my physician let me try that?" Which of the following responses by the nurse would be most appropriate? 1. "It's the physician's prerogative to decide how to treat you. The physician has chosen what is best for your situation." 2. "Tell me more about your friend's arthritic condition. Maybe I can answer that question for you." 3. "That drug is used for cases that are worse than yours. It wouldn't help you, so don't worry about it." 4. "Every person is different. What works for one client may not always be effective for another."

4. The nurse's most appropriate response is one that is therapeutic. The basic principle of therapeutic communication and a therapeutic relationship is honesty. Therefore, the nurse needs to explain truthfully that each client is different and that there are various forms of arthritis and arthritis treatment. To state that it is the physician's prerogative to decide how to treat the client implies that the client is not a member of his or her own health care team and is not a participant in his or her care. The statement also is defensive, which serves to block any further communication or questions from the client about the physician. Asking the client to tell more about the friend presumes that the client knows correct and complete information, which is not a valid assumption to make. The nurse does not know about the client's friend and should not make statements about another client's condition. Stating that the drug is for cases that are worse than the client's demonstrates that the nurse is making assumptions that are not necessarily valid or appropriate. Also, telling the client not to worry ignores the underlying emotions associated with the question, totally discounting the client's feelings.

A client with rheumatoid arthritis tells the nurse, "I know it is important to exercise my joints so that I won't lose mobility, but my joints are so stiff and painful that exercising is difficult." Which of the following responses by the nurse would be most appropriate? 1. "You are probably exercising too much. Decrease your exercise to every other day." 2. "Tell the physician about your symptoms. Maybe your analgesic medication can be increased." 3. "Stiffness and pain are part of the disease. Learn to cope by focusing on activities you enjoy." 4. "Take a warm tub bath or shower before exercising. This may help with your discomfort."

4. "Take a warm tub bath or shower before exercising. This may help with your discomfort." Superficial heat applications, such as tub baths, showers, and warm compresses, can be helpful in relieving pain and stiffness. Exercises can be performed more comfortably and more effectively after heat applications. The client with rheumatoid arthritis must balance rest with exercise every day, not every other day. Typically, large doses of analgesics, which can lead to hepatotoxic effects, are not necessary. Learning to cope with the pain by refocusing is inappropriate.

Which collaborative health-care team member should the nurse refer the client to in the late stages of myasthenia gravis? 1. Occupational therapist. 2. Recreational therapist. 3. Vocational therapist. 4. Speech therapist.

4. Speech therapist. 1. The occupational therapist assists the client with ADLs, but with MG the client has no problems with performing them if the client takes the medication correctly (30 minutes prior to performing ADLs). 2. A recreational therapist is usually in a psychiatric unit or rehabilitation unit. 3. A vocational therapist or counselor helps with the client finding a job which accommodates the disease process; clients with MG are usually not able to work in the late stages. 4. Speech therapists address swallowing problems, and clients with MG are dysphagic and at risk for aspiration. The speech therapist can help match food consistency to the client's ability to swallow, which enhances client safety.

1) 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

A) Systemic lupus erythematosus Explanation: A) 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.

2. A nurse is teaching a client who has SLE about self-care. Which of the following statements by the client indicates an understanding of the teaching? A. "I should limit my time to 10 minutes in the tanning bed." B. "I will apply powder to any skin rash." C."I should use a mild hair shampoo." D."I will inspect my skin once a month for rashes."

A- A client who has SLE should avoid the use of tanning beds, as well as prolonged sun exposure. B- A client who has SLE should apply steroid-based creams to skin rashes, not a powder. *C. CORRECT:* A client who has SLE should use a mild hair shampoo that does not irritate the scalp. D- A client who has SLE should inspect her skin daily for any open areas or rashes.

Which clinical manifestation would cause the nurse to suspect that the client is diagnosed with systemic lupus erythematosus? A- Joint edema and tenderness B- Red, burning, tearing eyes C- Chest tightness with wheezing on expiration D- Fever and night sweats

A- Joint edema and tenderness Clinical features of systemic lupus erythematosus involve multiple body systems. When the musculoskeletal system is involved, the client exhibits joint tenderness, edema, and morning stiffness. Eyes that are red, burning, and tearing are commonly associated with allergic rhinitis (i.e., hay fever). Chest tightness and wheezing on expiration are associated with allergic asthma. Fever and night sweats are manifestations of acquired immunodeficiency syndrome.

Adalimumab (Humira) is given to a client for the treatment of rheumatoid arthritis. Which of the following side effect is associated with the medication? A- Numbness. B- Diarrhea. C- Urinary retention. D- Weight gain.

A- Numbness. Adalimumab (Humira) has been associated with neurological side effects such as numbness, tingling, dizziness, visual disturbances, and weakness in the legs). B, C, D: Options B, C, and D are not associated with the use of medication. Nurselabs

The terminally ill client diagnosed with ALS has a DNR order in place and is currently complaining of "pain all over." The nurse notes the client has shallow breathing and a P 67, R 8, B/P 104/62. Which intervention should the nurse implement? A. Administer the narcotic pain medication IVP. B. Turn and reposition the client for comfort. C. Refuse to administer pain medication. D . Notify the HCP of the client's vital signs.

A. Administer the narcotic pain medication IVP. A) The nurse should administer the IVP narcotic pain medication even if the client has shallow breathing, with respirations of 8. A nurse should never administer a medication with the intent of hastening the client's death, but medicating a dying client to achieve a peaceful death is an appropriate intervention B) Repositioning the client would not be effective for "pain all over." C) This is cruel to do to a client who is dying and has made himself or herself a DNR D) The HCP has all the orders needed in place. There is no reason to notify the HCP.

5. You're preparing to help the neurologist with conducting a Tensilon test. Which antidote will you have on hand in case of an emergency?* A. Atropine B. Protamine sulfate C. Narcan D. Leucovorin

A. Atropine Atropine will help reverse the effects of the drug given during a Tensilon test, which is Edrophonium, in case an emergency arises. Edrophonium is a short-acting cholinergic drug, while atropine is an anticholinergic.

4. 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. "It is a procedure where the affected joint is removed and each end of the bones found within that joint are fused together." An arthrodesis (also called joint fusion) is where the affected joint is removed and the bones within it are fused together. Option B describes a joint replacement. Option C is known as a surgical cleaning. Option D is known as a synovectomy. Registered Nurse RN

5. A nurse is caring for a client who has SLE and is experiencing an episode of Raynaud's phenomenon. Which of the following findings should the nurse anticipate? A. Swelling of joints of the fingers B. Pallor of toes with cold exposure C. Feet that become reddened with ambulation D. Client report of intense feeling of heat in the fingers

A. Swelling, pain, and joint tenderness are findings in a client who has SLE and is not specific to an episode of Raynaud's phenomenon. *B. CORRECT:* Pallor of the extremities occurs in Raynaud's phenomenon in a client who has SLE and has been exposed to cold or stress. C. The extremities becoming red, white, and blue when exposed to cold or stress is characteristic of an episode of Raynaud's phenomenon in a client who has SLE. D. A client report of intense pain in the hands and feet is characteristic of an episode of Raynaud's phenomenon in a client who has SLE. NCLEX® Connection: Physiological Adaptation, Pathophysiology

4. A nurse is assessing a client who has SLE. Which of the following findings should the nurse expect? A. Weight loss B. Petechiae on thighs C. Systolic murmur D. Alopecia

A. Weight gain can occur in a client who has SLE due to being treated with corticosteroids. This is an adverse effect of this medication. B. A butterfly rash on the face is a finding in a client who has lupus. C. A cardiac friction rub is an expected finding of SLE. *D. CORRECT:* Alopecia (hair loss) is an expected finding in a client who has SLE. NCLEX® Connection: Physiological Adaptation, Pathophysiology

A nurse assesses a client diagnosed with systemic lupus erythematosus (SLE). Which symptoms does the nurse expect to see? SATA 1- Recurrent urinary tract infections 2- Persistent fatigue 3- Raised, red facial rash 4- Chronic dry, itchy eyes 5- Protein present on urinalysis

ANS 2, 3, 5 Although kidney involvement is common in SLE, urinary tract infections are not an indicator of kidney involvement. Recurrent urinary tract infections are more often caused by urinary retention, diabetes, or poor hygienic practices Fatigue is a common symptom of many autoimmune disorders, including SLE. The classic "butterfly" rash on the cheeks and nose is a common symptom of SLE. Dry, itchy eyes, and dry mouth are symptoms of the autoimmune disease Sjögren syndrome. Kidney involvement in SLE is common and known as lupus nephritis. This is a major cause of death in SLE. Proteinuria, hematuria, and fluid retention are all symptoms of kidney involvement in SLE. Explanation SLE is a systemic autoimmune disease that is more common in women than in men. Treatment is aimed at relieving symptoms and preventing the complications that may come with immunosuppressive drugs. Infection is a major cause of death, most commonly pneumonia. A butterfly rash over the cheeks and bridge of the nose is a classic sign of SLE. Other signs include proteinuria, chest pain with inspiration, fatigue, fever, general discomfort, alopecia (hair loss), mouth dryness and sores, photosensitivity, and muscle pain and weakness. Nursing diagnoses include fatigue, impaired skin integrity, and impaired comfort.

A client diagnosed with systemic lupus erythematosus (SLE) asks the nurse whether the client's children will get the disease. The nurse provides which information to the client? 1- "SLE is more common in underweight people." 2- SLE is usually diagnosed after age 50." 3- "SLE is more common in females than in males." 4- "SLE runs in families." 5- "SLE is more common in Caucasians."

ANS 3,4 Being overweight increases the risk of developing an autoimmune disorder SLE is most commonly diagnosed after puberty, typically in the 20s and 30 Women are ten times more likely to develop SLE than men are. SLE has a genetic link and tends to be hereditary. SLE is most common in black women, having four times the prevalence than white women, and is also prevalent in Hispanics and Asians. SLE is a systemic autoimmune disease typically affecting the skin, joints, and serous membranes, along with the renal, hematologic, and neurologic systems. In the United States, the incidence is approximately 2 to 8 in 100,000. It is a chronic disease with periods of exacerbation and remission. Hormones seem to play a part in the etiology of SLE, along with sun exposure, infection, and exposure to certain drugs, especially antiseizure drugs. Nclex mastery

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.

ANS: 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. The genetic link, specifically HLA-DR4, has been found in 65% of clients with RA. People with osteoarthritis are not necessarily at risk for developing rheumatoid arthritis.

8. You're teaching a group of nursing students about Guillain-Barré Syndrome and how it can affect the autonomic nervous system. Which signs and symptoms verbalized by the students demonstrate they understood the autonomic involvement of this syndrome? A. Altered body temperature regulation B. Inability to move facial muscles C. Cardiac dysrhythmias D. Orthostatic hypotension E. Bladder distension

ANS: A, C, D, E

The nurse is assisting with care of a resident diagnosed with amyotrophic lateral sclerosis (ALS). Which assessment findings does the nurse anticipate? (Select all that apply.) a. Progressive weakness b. Pill-rolling tremor c. Ascending paralysis d. Hemiparesis e. Decreased coordination of extremities f. Bradykinesia

ANS: A, E Primary symptoms of ALS include progressive muscle weakness and decreased coordination of arms, legs, and trunk. Atrophy of muscles and twitching (fasciculations) also occur. Pill-rolling tremor and bradykinesia are symptoms of Parkinson's disease. Ascending symptoms occur in Guillain-Barré syndrome. Paralysis on one side of the body occurs in strokes.

1. 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?"

ANS; 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. 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. Registered Nurse RN

5) 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.

6) A nurse is caring for a client with systemic lupus erythematosus (SLE). The client begins to cry and tells the nurse that she is afraid that her skin will be disfigured with lesions. Which intervention does the nurse plan to teach this client to minimize skin infections associated with SLE? Select all that apply. A) Use sunscreen with an SPF of 15 or greater. B) Remain indoors on sunny days. C) Avoid swimming in a pool or the ocean. D) Avoid sun exposure between 10:00 a.m. and 3:00 p.m. E) Decrease sun exposure between 3:00 p.m. and 5:00 p.m.

Answer: A, D The nurse teaches the client to live a normal life with a few extra precautions. There is a relationship between sun exposure and infection, so the client is taught to use sunscreen with an SPF of at least 15 and to avoid the sun between 10:00 a.m. and 3:00 p.m. The client may swim but should reapply sunscreen after swimming. The client does not need to stay indoors on sunny days or to decrease sun exposure between 3:00 p.m. and 5:00 p.m.

The nurse is performing an assessment on a patient with amyotrophic lateral sclerosis (ALS). Which of the following symptoms would the nurse expect to find? SATA A) Urinary incontinence B) Asymmetric muscle weakness C) Nasal vocal quality D) Fatigue E) Muscle weakness beginning in lower extremities

Answer: B, C and D. Function of the anal and bladder sphincters usually remains intact with patients with ALS because the disease does not affect those nerves. Muscle weakness usually begins in the distal upper extremities. Fatigue, nasal vocal quality, and assymetric muscle weakness are all signs of ALS

A client diagnosed with ALS is dealing with muscle spasticity. Which of the following medications is most likely to be prescribed? A) Hydralazine B) Baclofen (Lioresal) C) Lidocaine (Xylocaine) D) Methylpredinsolone (Solu-Medrol)

B) Baclofen (Lioresal) Baclofen is a skeletal muscle relaxant and is the first drug of choice for muscle spasms in ALS, MS and MG.

4. A 25 year-old presents to the ER with unexplained paralysis from the hips downward. The patient explains that a few days ago her feet were feeling weird and she had trouble walking and now she is unable to move her lower extremities. The patient reports suffering an illness about 2 weeks ago, but has no other health history. The physician suspects Guillain-Barré Syndrome and orders some diagnostic tests. Which finding below during your assessment requires immediate nursing action? A. The patient reports a headache. B. The patient has a weak cough. C. The patient has absent reflexes in the lower extremities. D. The patient reports paresthesia in the upper extremities.

B. The patient has a weak cough. The patient's signs and symptoms in this scenario are typical with Guillain-Barré Syndrome. The syndrome tends to start in the lower extremities (with paresthesia that will progress to paralysis) and migrate upward. The respiratory system can be affected leading to respiratory failure. Therefore, the nurse should assess for any signs and symptoms that the respiratory system may be compromised (ex: weak cough, shortness of breath, dyspnea...patient says it is hard to breath etc.). The nurse should immediately report this to the MD because the patient may need mechanical ventilation. Absent reflexes is common in GBS and paresthesia can extend to the upper extremities as the syndrome progresses. A headache is not common.

11. The patient's lumbar puncture results are back. Which finding below correlates with Guillain-Barré Syndrome? A. high glucose with normal white blood cells B. high protein with normal white blood cells C. high protein with low white blood cells D. low protein with high white blood cells

B. high protein with normal white blood cells

1. Myasthenia gravis occurs when antibodies attack the __________ receptors at the neuromuscular junction leading to ____________.* A. metabotropic; muscle weakness B. nicotinic acetylcholine; muscle weakness C. dopaminergic adrenergic; muscle contraction D. nicotinic adrenergic; muscle contraction

B. nicotinic acetylcholine; muscle weakness In myasthenia gravis, either the nicotinic acetylcholine receptors are attacked by antibodies created by the immune system (hence why this disease is considered autoimmune) or antibodies are inhibiting the function of muscle-specific kinase (which is a receptor tyrosine kinase that helps with maintaining and building the neuromuscular junction). Either way this leads to the neurotransmitter acetylcholine from being able to communicate with the muscle fiber to make it contract.

2) 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."

C) "Pregnancy is often associated with an SLE exacerbation." 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.

3. A patient with myasthenia gravis will be eating lunch at 1200. It is now 1000 and the patient is scheduled to take Pyridostigmine. At what time should you administer this medication so the patient will have the maximum benefit of this medication?* A. As soon as possible B. 1 hour after the patient has eaten (at 1300) C. 1 hour before the patient eats (at 1100) D. at 1200 right before the patient eats

C. 1 hour before the patient eats (at 1100) Pyridostigmine is an anticholinesterase medication that will help improve muscle strength. It is important the patient has maximum muscle strength while eating for the chewing and swallowing process. Therefore, the medication should be given 1 hour before the patient eats because this medication peaks (has the maximum effect) at approximately 1 hour after administration. How does the medication improve muscle strength? It does this by preventing the breakdown of acetylcholine. Remember the nicotinic acetylcholine receptors are damaged and the patient needs as much acetylcholine as possible to prevent muscle weakness. Therefore, this medication will allow more acetylcholine to be used...hence improving muscle strength.

A nurse is teaching a client who has ALS about a new medication for riluzole. Which of the following instructions should the nurse give to the patient ? A. Take this medication immediately prior to eating B. Drink a glass of milk with this medication C. Avoid consuming alcoholic beverages D. Monitor your blood pressure daily

C. Avoid consuming alcoholic beverages A) Riluzole should be taken on an empty stomach every 12 hrs, either 1 hr before or 2 hrs after meals B) Riluzole should be taken on an empty stomach C) Riluzole is hepatotoxic alcohol may result in liver damage D) Riluzole does not effect blood pressure

3. 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. Synovitis, development of pannus, anklyosis 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. Registered Nurse RN

The nurse is providing dietary instructions to the client with systemic lupus erythematosus. Which of the following dietary items would the nurse instruct the client to avoid? A- Cantaloupe B- Turkey C- Broccoli D- Steak

D- Steak The client with systemic lupus erythematosus (SLE) is at risk for cardiovascular disorders such as coronary artery disease and hypertension. The client is advised of lifestyle changes to reduce these risks, which include smoking cessation and prevention of obesity and hyperlipidemia. The client is advised to reduce salt, fat, and cholesterol intake.

4. The neurologist is conducting a Tensilon test (Edrophonium) at the bedside of a patient who is experiencing unexplained muscle weakness, double vision, difficulty breathing, and ptosis. Which findings after the administration of Edrophonium would represent the patient has myasthenia gravis? A. The patient experiences worsening of the muscle weakness. B. The patient experiences wheezing along with facial flushing. C. The patient reports a tingling sensation in the eyelids and sudden ringing in the ears. D. The patient experiences improved muscle strength.

D. The patient experiences improved muscle strength. During a Tensilon test Edrophonium is administered. This medication prevents the breakdown of acetylcholine, which will allow more of the neurotransmitter acetylcholine to be present at the neuromuscular junction....hence IMPROVING muscle strength IF myasthenia gravis is present. Therefore, if a patient with MG is given this medication they will have improved muscle strength.

2. During nursing report you learn that the patient you will be caring for has Guillain-Barré Syndrome. As the nurse you know that this disease tends to present with: A. signs and symptoms that are unilateral and descending that start in the lower extremities B. signs and symptoms that are symmetrical and ascending that start in the upper extremities C. signs and symptoms that are asymmetrical and ascending that start in the lower extremities D. signs and symptoms that are symmetrical and ascending that start in the lower extremities

D. signs and symptoms that are symmetrical and ascending that start in the lower extremities GBS signs and symptoms will most likely start in the lower extremities (ex: feet), be symmetrical, and will gradually spread upward (ascending) to the head. There are various forms of Guillain-Barré Syndrome. Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) is the most common type in the U.S. and this is how this syndrome tends to present.

8. 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)

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

6. 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."

The answer is 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. Registered Nurse RN

10. You're a home health nurse providing care to a patient with myasthenia gravis. Today you plan on helping the patient with bathing and exercising. When would be the best time to visit the patient to help these tasks? A. Mid-afternoon B. Morning C. Evening D. Before bedtime

The answer is B. Patients with MG tend to have the best muscle strength in the morning after sleeping or resting rather than at the end of the day....the muscles are tired from being used and the muscle become weaker as the day progresses etc. Therefore any rigorous activities are best performed in the morning or after the patient has rested.

9. 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

The answer is 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. Registered Nurse RN

10. 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

The answers are A, C, and E. These are diagnostic tests to help diagnose RA. Option B is used in gout, and option D is used with osteoporosis. Registered Nurse RN

7. 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)

The answers are B, E, and F. These are DMARDs that can be prescribed for RA. Option A is a corticosteroid. Option C and D are sometimes prescribed in osteoporosis. Registered Nurse RN

3. You're assessing a patient's health history for risk factors associated with developing Guillain-Barré Syndrome. Select all the risk factors below: A. Recent upper respiratory infection B. Patient's age: 3 years old C. Positive stool culture Campylobacter Jejuni D. Hyperthermia E. Epstein-Barr F. Diabetes G. Myasthenia Gravis

The answers are: A, C, and E. Risk factors for developing Guillain-Barré Syndrome include: experiencing upper respiratory infection, GI infection (especially from Campylobacter Jejuni), Epstein-Barr infection, HIV/AIDS, vaccination (flu or swine flu) etc

When caring for a patient who has Guillain-Barré syndrome, which assessment data obtained by the nurse will require the most immediate action? a. The patient complains of severe tingling pain in the feet. b. The patient has continuous drooling of saliva. c. The patient's blood pressure (BP) is 106/50 mm Hg. d. The patient's quadriceps and triceps reflexes are absent.

b. The patient has continuous drooling of saliva. A) The foot pain should be treated with appropriate analgesics B) Drooling indicates decreased ability to swallow, which places the patient at risk for aspiration and requires rapid nursing and collaborative actions such as suctioning and possible endotracheal intubation C) The BP requires ongoing monitoring, but this actions are not as urgently needed as maintenance of respiratory function. D) Absence of the reflexes should be documented, but this is a common finding in Guillain-Barré syndrome.

The nurse is educating the family of a patient in the late stages of amyotrophic lateral sclerosis (ALS). What teaching point is most important for the nurse to include? a. The patient's ability to move the upper limbs may be affected. b. The patient's cognitive and mental capacity will most likely remain intact throughout the disease progression. c. The patient's breathing should not be affected by the disease. d. The patient's ability to swallow will remain intact.

b. The patient's cognitive and mental capacity will most likely remain intact throughout the disease progression Whereas the ability to move the upper limbs will likely be affected by the disease, it is important for families to remember that the patient's cognitive and mental capacity stays intact as the motor activity rapidly declines. Breathing and swallowing are often significantly affected by ALS.

A client with advanced ALS is admitted to the hospital. Because of manifestations that are common in clients with ALS, the nurse should: a. attempt to institute bowel-training activities. b. provide the client with small, frequent feedings. c. obtain an order for intermittent catheterization. d. orient the client to his or her surroundings frequently.

b. provide the client with small, frequent feedings. The course of the disease is relentlessly progressive. Cognition, as well as bowel and bladder sphincters, remains intact. The client may be malnourished because of dysphagia. Encourage small, frequent, high-nutrient feedings. The nurse should assess for aspiration and choking. A feeding tube may be considered during the course of the illness.

A patient with Guillain-Barré syndrome who has numbness and weakness of both feet is hospitalized . The nurse will anticipate that collaborative interventions at this time will include? a. intubation and mechanical ventilation. b. insertion of a nasogastric (NG) feeding tube. c. administration of methylprednisolone (Solu-Medrol). d. IV infusion of immunoglobulin (Sandoglobulin).

d. IV infusion of immunoglobulin (Sandoglobulin). Because the Guillain-Barré syndrome is in the earliest stages (as evidenced by the symptoms), use of high-dose immunoglobulin is appropriate to reduce the extent and length of symptoms