Rheumatoid Arthritis
Gallbladder
GI Bleed
Osteo-arthritis
Medications
100
A client is experiencing an acute exacerbation of rheumatoid arthritis. What should the nursing priority be??? A. providing comprehensive client teaching; including symptoms of the disorder, treatment options, and expected outcomes. ?B. Administering ordered analgesics and monitoring their effects. ?C. Performing meticulous skin care. ?D. Supplying adaptive devices, such as a zipper-pull, easy to open beverage cartons, lightweight cups and unpackaged silverware.
What is B. Administering ordered analgesics and monitoring their effects. ?? Rationale: An acute exacerbation of rheumatoid arthritis can be very painful, and the nurse should make pain management her priority. Client teaching, skin care, and supplying adaptive devices are important, but these actions do not take priority over pain management.
100
A 42 year old female patient comes into the ED complaining of right upper quadrant pain that radiates to her right shoulder, the RN believes the patient may have Cholecystitis so she checks for which assessment sign during abdominal palpation? ?? A. Murphy’s sign ?B. Alatrash’s sign? C. Blumber’s sign? D. Allen’s sign
What is A. Murphy’s sign?? Rationale: Murphy’s sign is tested for during an abdominal examination it is performed by asking the patient to breathe out and then gently placing the hand below the coastal margin on the right side at the midclavicular line (The approximate location of the gallbladder). The patient is then instructed to inspire (breathe in). Normally, during inspiration, the abdominal contents are pushed downward as the diaphragm moves down (and lungs expand). AS the gallbladder is tender and, in moving downward, comes in contact with the examiner’s fingers cause the patient pain.
100
Which diagnostic test would be used first to evaluate a client with upper GI bleeding??? A. Endoscopy? B. Upper GI series? C. Hemoglobin (Hb) levels and hematocrit (HCT) ?D. Arteriography
What is A. Endoscopy?? Rationale: A endoscopy permits direct evluation of the upper GI tract and can detect 80% of bleeding lesions. An upper GI series is also less accurate than endoscopy. Although an upper Gi serious might confirm the presence of a lesion, it would’nt necessarily reveal whether the lesion is bleeding levels. Hb levels and HCT, which indicate loss blood volume, aren’t always reliable indicators of GI bleeding because a decrease in these values may not be seen for several hours. Arteriography is an invasive study associated with life-threatening complications and wouldn’t be used for an initial evaluation.
100
A patient asks the nurse to explain what “bone crepitus” means. The nurse explains that “bone crepitus” is the… ?? A. Sensation of bone rubbing against bone ?B. Sensation of weakness in the bone ?C. Sensation of bubbles in the bone? D. Sensation of hitting your funny bone
What is C. Sensation of bubbles in the bone. Rationale: Gas can build up in the areas surrounding the joint forming tiny bubbles in the synovial fluid.
100
A client is taking docusate sodium (Colace). The nurse monitor which of the following to determine whether the client is having a therapeutic effect from this medication??? A. Abdominal pain? B. Reduction in steatorrhea? C. Hematest-negative stools ?D. Regular bowel movements
What is D. Regular bowel movements ??Rationale: Colace is laxative prescribed to treat occasional constipation, as well as constipation associated with certain medical conditions. Docusate sodium works by allowing water and fats to get into the stool. This helps soften the stool and makes passing stool more comfortable.
200
A client has been on treatment for rheumatoid arthritis for three weeks. During the administration of etanercept, which is most important for the nurse to assess? ?? A. The injection site for itching and edema.? B. The white blood cell counts and platelet counts.? C. Whether the client is experiencing fatigue and joint pain. ?D. Whether the client is experiencing a metallic taste in the mouth and loss of appetite.
What is B. The white blood cell count and platelet counts.?? Rationale: Infection and pancytopenia are side effects of entanercept. Laboratory studies are performed prior and during medication treatment. The appearance of abnormal WBC counts and abnormal platelet counts can alert the nurse to a potentially life threatening infection. Infection site itching is a common occurrence following administration. A metallic taste and loss of appetite are not common signs of side/adverse effects.
200
What are risk factors for Cholecystitis? (Select all that apply).?? A. It is more common in women? B. It is more common in men ?C. Rapid weight loss? D. Type 1 Diabetes ?E. A diet rich in HDL
What is A, C, D.?? Rationale: Risk factors include a high dietary intake of fats and carbohydrates, a sedentary lifestyle, type 1 and 2 diabetes mellitus which causes high triglyceride levels, and dyslipidemia (increased triglycerides and low HDL). A diet high fats and carbohydrates predisposes a patient to obesity, which increases cholesterol synthesis, biliary secretion of cholesterol, and cholesterol hypersaturation. Approximately 60% of patients with acute cholecystitis are women; however, the disease tends to be more severe in men.
200
A client is admitted to the health care facility with a diagnosis of a bleeding gastric ulcer. The nurse expects this client’s stool to be:?? A. Coffee-ground like ?B. Clay-colored? C. Black and Tarry? D. Bright red
What is C. Black and tarry.?? Rationale: Black tarry stools are a sign of bleeding in the upper GI tract form a gastric ulcer and the results of a digestive enzymes on blood.
200
What are some warning signs that a patient may have osteoarthritis??? A. Patient becomes short of breath after walking for 15 minutes.? B. Patient has an elevated erythrocyte sedimentation rate. ?C. Patient has stiffness in a joint after getting out of bed or sitting for a long time.? D. Patient is taking NSAIDs around the clock to deal with pain.
What is C. Patient has stiffness in a joint after getting out of bed or sitting for a long time.?? Rationale: Normal symptoms of osteoarthritis include joint stiffness after a period of disuse, such as after sleeping or sitting for an extended period of time. Other symptoms include swelling or tenderness in their joints, and a crunching feeling or the sound of bone rubbing on bone.
200
At which of the following times should the nurse instruct the client to take ibuprofen (Motrin), prescribed for left hip pain secondary to osteoarthritis, to minimize gastric mucosal irritation??? A. At bedtime? B. On arising? C. Immediately after a meal? D. On an empty stomach
What is C. Immediately after a meal ??Rationale: Drugs that cause gastric irritation are best take after or with a meal, when stomach contents help minimize the local irritation. Taking the medication on an empty stomach at any time during the day will lead to gastric irritation. (Taking the drug at bedtime with food may cause the client to gain weight, possible aggravating the osteoarthritis. When the client arises, he is still from immobility and should use warmth and stretching until he gets food in his stomach.
300
A client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct??? A. “OA is a noninflammatory joint disease. RA is characterized by inflamed swollen joints.” ?B. “OA and RA are very similar. OA affects smaller joints and RA affects the larger, weight bearing joints.”? C. “OA affects joints on both sides of the body. RA is usually unilateral.” ?D. “OA is more common in women. RA is more common in men.” ?
What is A. “OA is a noninflammatory joint disease. RA is characterized by inflames swollen joints” ?? Rationale: OA is a degenerative arthritis, characterized by the loss of cartilage of the articular surfaces of weight bearing joints with spur development. RA is characterized by inflammation of synovial membranes and surrounding structures. OA may occur in one hip or knee and not the other, whereas RA commonly affects the same joints bilaterally. RA is more common in women; OA affects both sexes equally.
300
A RN in a clinic is reviewing the lab values of a patient who has a suspected cholelithiasis. Which of the following would be an expected finding for cholelithiasis??? A. Serum cholesterol of 150 mg/dl ?B. Direct bilirubin of 2.4 mg/dl? C. WBC of 10,011/uL? D. Serum albumin 3.9 g/dl
What is B. Direct bilirubin of 2.4 mg/dl?? Rationale: Direct bilirubin levels are increased with patient who have gallstones. Serum albumin levels are not indicators of cholelithiasis and is in the expected range. WBC is increased with gallstones. Serum cholesterol levels would be greater than 200 mg/dl.
300
The most frequent cause of UGI bleeding is:?? A. Esophageal varices? B. Peptic ulcer disease ?C. Angiomata? D. Mallory Weiss tear? E. Gastritis
What is B. Peptic ulcer disease.?? Rationale: Peptic ulcer disease is the most common cause of UGI bleeding, accounting for 50% of cases. Other etiologies are far less common.
300
A patient asks the nurse about what he can do to fix his newly diagnosed osteoarthritis. What is the correct response from the nurse? ?? A. Losing weight will help by putting less pressure on your joints, which will help relieve pain. ? B. Taking pain medication is the only way to deal with your problem.? C. Using a cane on the unaffected side will make it easier to go about your day. ?D. Getting a joint replacement surgery will alleviate a lot of your problems.
What is A. Losing weight will help by putting less pressure on your joints, which will help relieve your pain. ?? Rationale: Since it is newly diagnosed, you will want to go with the easiest and least invasive method first, so surgery is out. Using a cane is a good solution, but will not help them in the long run like weight loss will.
300
The client recently diagnosed with Rheumatoid Arthritis is prescribed aspirin, an NSAID. Which comment by the client would warrant immediate intervention by the nurse? A. “I always take aspirin with food.”? B. “If I have dark stools, I will call my HCP.”? C. “Aspirin will not cure my arthritis.”? D. “I am having some ringing in my ears.”
What is D. “I am having some ringing in my ears.” ??Rationale: Tinnitus (ringing in the ear) is a sign of aspirin toxicity and the client should be instructed to decrease aspirin dosage or stop taking aspirin altogether and contact the provider.
400
A patient with rheumatoid arthritis is experiencing articular involvement of the joints. The Nurse recognizes that these characteristic changes include (select all that apply)?? A. Bamboo-shaped fingers? B. Metatarsal head dislocation in feet ?C. Noninflammatory pain in large joints ?D. Asymmetric involvement of small joints ?E. Morning stiffness lasting 60 min or more
What is B, E.?? Rationale: Morning stiffness may last from 60 minutes to several hours or more, depending on disease activity. Metatarsal head dislocation and subluxation in the feet may cause pain and walking disability. Joint symptoms occur symmetrically and frequently affect the small joints of the hands and feet. Larger peripheral joints such as the wrists, elbows, shoulders, knees, hips, anles, and jay may also be involved. Rheumatoid arthritis (RA) is an inflammatory disorder. In early disease, the fingers may become spindle-shaped from synovial hypertrophy and thickening of the joint capsule. ?
400
After a laparoscopic cholecystectomy a RN is providing discharge teaching to a client, which of the following should she include in her teaching? ?? A. Do not return to work for 3 weeks. ?B. Expect some bile colored drainage at the incision.? C. Follow a lower-fat diet for several weeks after surgery.? D. Keep the bandages on until your follow up doctor’s appointment.
What is C. Follow a lower-fat for several weeks after surgery. ?? Rationale: Although the usual diet can be resumed, a low-fat diet is usually better tolerated for several weeks following surgery. Normal activities can be gradually resumed as the patient tolerates. Bile-colored drainage may indicate infection. the bandage may be removed the day after surgery.
400
After initial stabilization and resuscitation of the patient, each of the following options should be considered in the management of UGI bleeding except:?? A. Determine the source of bleeding ?B. Stop acute bleeding ?C. Treat the underlying abnormality? D. Prevent rebleeding? E. Emergency surgery
What is E. Emergency surgery?? Rationale: After a patient with UGI hemorrhage is stabilized, each of the above statements is an appropriate therapeutic goal in the management of UGI bleeding except answer E. Surgery becomes a therapeutic option for patients with severe UGI hemorrhage is endoscopic hemostasis fails or if there is severe recurrent hemorrhage.
400
Osteoarthritis affecting the distal interphalangeal joints is known as: ?? A. Richard’s nodes ?B. Bouchard’s nodes ?C. Alatrash’s nodes? D. Heberden’s nodes
What is D. Heberden’s nodes?? Rationale: Bouchard’s nodes affect the proximal interphalangeal joints. The other two do not exist.
400
A nurse teaches a client taking metoclopramide (Reglan) to discontinue the medication immediately and call the physician if which side effect occurs with long-term use??? A. Excessive excitability? B. Anxiety or irritability? C. Uncontrolled rhythmic movements of the face or limbs? D. Dry mouth not helped by the use of sugar-free hard candy.
What is C. Uncontrolled rhythmic movements of the face or limbs?? Rationale: If the client experiences tardive dyskinesia (rhythmic movements of the face or limbs), the client should stop the medication and call the physician. These side effects may be irreversible.
500
A nurse 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 range of motion ?C. Hypersalivation? D. Decreased blood pressure ?E. Pain at rest
What is A, B, E?? A. Correct: exacerbating factors, such as a recent illness, are indicative of RA.? B. Correct: Decreased range of motion is indicative of RA.? C. Incorrect: xerostomia is indicative of RA.? D. Incorrect: Blood pressure changes are not indicative of RA.? E. Correct: pain at rest is characteristic of RA.
500
An RN is providing discharge teaching to a patient who has had an open approach cholecystectomy with a T-tube, which of the following statements indicate that the patient understands the instructions??? A. “I should expect to have some constipation.” ?B. “I will take baths rather than showers.” ?C. “I will remember to clamp my T-tube at least 1 hour before each meal.” ?D. “I will take extra care to keep the drainage system above the level of the gallbladder."
What is C. “I will remember to clamp my T-tube at least 1 hour before each meal.?? Rationale: The T-tube should be clamped 1-2 hours before and after meals to assess tolerance to food postcholycystectomy and prior to removal. Baths increase the risk for the introduction of organisms and infection. Diarrhea not constipation is more common. The drainage system should be kept level with the gallbladder, raising it may reflux or drainage into the wound bed which may cause infection.
500
A 73 year old man presents with severeal episodes of hematemesis. Examination shouws signs of orthostatic hypotension and melena. What is the first priority in caring for this patient? A. Nasogastric tube placement and gastric lavage.? B. Resuscitation with adequate IV access and appropriate fluid and blood product fusion. ?C. IV infusion of H2-receptor antagonists to stop the bleeding.? D. Urgent upper panendoscopy.? E. Urgent surgical consultation.
What is B. Resuscitation with adequate IV access and appropriate fluid and blood product fusion. ?? Rationale: In the setting of an UGI bleed, features of orthostatic hypotension should be corrected immediately and resuscitation instituted concurrently with the initial evaluation. IV access should be adequate and appropriate fluid and blood producs should be given. Only then should other aspects of the evaluation and care proceed with NG lavage, upper panendoscopy and surgical consultation. IV H2-receptio antagonist have not been shown to stop bleeding or reduce rebleeding.
500
THE HCP prescribes glucosamine and chondroitin for a client diagnosed with osteoarthritis. What is the scientific rationale for prescribing this medication??? A. It will help decrease the inflammation in the joints.? B. It improves tissue function and slows the breakdown of cartilage.? C. It increases the production of synovial fluid in the joints.? D. It is a potent medication which decreases the client’s joint pain.
What is B. It improves tissue function and slows the breakdown of cartilage.?? Rationale: Glucosamine and chondroitin are naturally found in connective tissue sin the human body, such as those covering the ends of bones in the joints. Glucosamine is thought to help with cartilage formation and repair, while chondroitin is part of a protein molecule that helps give cartilage its elastic properties. It’s important to note that these supplements still need to be sutdied further, as their true medicinal properties are still unknown.
500
A client with acute pancreatitis is experiencing severe abdominal pain. Which of the following medication orders should the nurse question? ?? A. Mylanta? B. Morphine ?C. Cimetidine ?D. Meperidine
What is B. Morphine?? Rationale: Morphine is contraindicated in patients with gallbladder disease and pancreatitis because it causes spasms of the Sphincter of Oddi.
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