crohns & UC
A patient with Crohn's Disease is taking corticosteroids. The patient is complaining of extreme thirst, polyuria, and blurred vision. What is your next nursing action?
A. Check the patient's blood glucose
B. Give the patient a food containing sugar (ex: orange juice)
C. Administer oxygen via nasal cannula
D. D. Assess bowel sounds
Answer: A.
A side effect of corticosteroids is hyperglycemia. Extreme thirst, polyuria, and blurred vision are classic signs and symptoms of hyperglycemia. Therefore, the nurse should check the patient's blood glucose to confirm the hyperglycemia.
Which finding is most characteristic of SLE?
A. Symmetrical joint pain with morning stiffness
B. Ulnar deviation and swan-neck deformities
C. Butterfly-shaped malar rash
D. Nodules over extensor surfaces
C — Butterfly-shaped malar rash
Classic SLE hallmark.
Which are common triggers of MS exacerbations? (Select 3)
A. Infection
B. Stress
C. High heat exposure
D. Alcohol consumption
E. Cold weather
Answer: A, B, C
Rationale:
Infection, stress, and heat can trigger MS flare-ups
Alcohol and cold weather are less significant triggers.
Which symptom is most characteristic of MG?
A. Joint swelling
B. Ptosis (drooping eyelids)
C. Rash on the trunk
D. Fever
Answer: B — Ptosis (drooping eyelids)
Rationale:
MG = autoimmune disorder affecting acetylcholine receptors, causing skeletal muscle weakness.
Common early signs: ptosis, diplopia, facial weakness.
Joint swelling, rash, or fever are not typical.
Which lab finding is most consistent with acute gout?
A. Serum uric acid 10 mg/dL
B. Serum calcium 6 mg/dL
C. WBC 2,500/mm³
D. ESR normal
A — Serum uric acid 10 mg/dL
Rationale:
Hyperuricemia is a hallmark of gout (>6.8 mg/dL).
Calcium, WBC, ESR may be normal or nonspecific.
All of the following blood studies are consistent with a positive diagnosis of rheumatoid arthritis (RA) except:
A. + C reactive protein (CRP)
B. + antinuclear antibody (ANA)
C. RBC count of < 4.0 million/uL
D. serum complement level (C3) of > 130 mg/dL
Answer = C
Labs consistent with RA: ↑ CRP, +ANA
Lab not consistent/required for RA diagnosis: RBC < 4.0 million/µL
True or False:
Guillain-Barré Syndrome occurs when the body's immune system attacks the myelin sheath on the nerves in the central nervous system.
FALSE:
Guillain-Barré Syndrome is an autoimmune neuro condition where the immune system attacks the nerves in the PERIPHERAL NERVOUS SYSTEM and cranial nerves. This condition does NOT occur in the central nervous system (CNS).
A patient is receiving treatment for Crohn's Disease. Which food found on the patient's food tray should the patient avoid?
A. Fresh Salad
B. White rice
C. Baked chicken
D. Cooked skinless apples
A.
pts who are experiencing flare-ups of Crohn's Disease should avoid high fiber foods, foods that are hard to digest, spicy foods, dairy products etc. Therefore, the patient should avoid a fresh salad. This contain vegetables which are high in fiber and hard to digest. The gut needs to rest. It is best for the patient to consume low fiber and high protein foods. White rice and fruits/vegetables that are cooked/skinless are low in fiber. Baked chicken is a good source of protein for the patient.
Which nursing intervention is appropriate for a client with SLE-related arthritis?
A. Encourage daily high-impact sports
B. Apply heat packs to sore joints
C. Teach frequent vigorous joint massage
D. Restrict all movement of affected joints
B — Apply heat packs to sore joints
Relieves stiffness and pain during flares.
High-impact exercise or vigorous massage may worsen inflammation.
A nurse is teaching a client with MS about fatigue management. Which intervention is appropriate?
A. Encourage activity in the morning and rest periods in the afternoon
B. Avoid all activity to conserve energy
C. Exercise intensely in the evening
D. Ignore fatigue and push through
Answer: A — Activity in the morning with rest periods
Rationale:
MS fatigue is worse later in the day
Energy conservation and pacing are key
Overexertion worsens symptoms; ignoring fatigue is unsafe.
Which statement by the client indicates correct understanding of pyridostigmine therapy?
A. “I can skip doses if I feel strong in the morning.”
B. “I should take this medication on time every day to maintain muscle strength.”
C. “This medication will cure MG completely.”
D. “I should stop the medication during fatigue.”
Answer: B — Take medication on time every day
Rationale:
Pyridostigmine = cholinesterase inhibitor, improves neuromuscular transmission.
Consistent dosing is essential to prevent muscle weakness.
MG has no cure; skipping doses or stopping medication can trigger weakness or crisis.
A client with gout is prescribed allopurinol. Which statement indicates the client understands the teaching?
A. “I should take this medication only during flare-ups.”
B. “I may need to avoid purine-rich foods like red meat and shellfish.”
C. “This medication works immediately to relieve pain.”
D. “I do not need to drink extra fluids while taking this medication.”
B — Avoid purine-rich foods
Rationale:
Allopurinol lowers uric acid levels over time.
Purine-rich foods (red meat, shellfish) increase uric acid and trigger attacks.
Allopurinol is for prevention, not acute pain relief, and fluids are important to prevent kidney stones.
A client with RA reports morning stiffness lasting 2 hours, fatigue, and warm swollen joints in hands and wrists. Which lab finding supports this diagnosis?
A. Increased TSH
B. Decreased ESR
C. Positive rheumatoid factor and elevated CRP
D. Elevated lipase and amylase
C — Positive RF + elevated CRP
Classic inflammatory markers for RA.
A client with suspected Guillain-Barré syndrome is being admitted. Which assessment finding does the nurse expect?
A. Tremors that worsen with movement
B. Ascending symmetric muscle weakness
C. Bradykinesia and shuffling gait
D. Sudden unilateral facial drooping
Answer: B
Rationale: GBS typically presents as rapidly progressing, ascending, symmetric muscle weakness starting in the legs and moving upward. Tremors and bradykinesia relate to Parkinson’s; unilateral facial droop suggests stroke.
A client with Crohn’s disease is malnourished. Which nursing action is the highest priority?
A. Offer high-protein, high-calorie foods
B. Monitor albumin and prealbumin levels
C. Start a low-residue diet
D. Encourage 2–3 L of water daily
A.
Malnutrition must be corrected first.
A client with SLE is prescribed hydroxychloroquine. Which teaching is most important?
A. “You may need regular eye exams to prevent vision problems.”
B. “Take this medication only during flare-ups.”
C. “You may experience excessive urination.”
D. “Avoid NSAIDs while taking this medication.”
A — Eye exams
Hydroxychloroquine can cause retinal toxicity, requires annual ophthalmologic evaluation.
Which symptom is most characteristic of MS?
A. Sudden, symmetrical paralysis
B. Paresthesia, numbness, or tingling in extremities
C. Constant high fever
D. Severe joint pain
Answer: B — Paresthesia, numbness, or tingling
Rationale:
MS = demyelination of CNS → sensory deficits like numbness, tingling, paresthesia.
Sudden paralysis = stroke; fever = infection; joint pain = arthritis.
The neurologist is conducting a Tensilon test at the bedside of a pt 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
The answer is D.
During a Tensilon test Edrophonium is administered.
This med 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.
Which lifestyle modification should the nurse recommend to prevent gout attacks?
A. Increase alcohol and red meat intake
B. Maintain adequate hydration and a low-purine diet
C. Avoid exercise entirely
D. Restrict fluids to prevent swelling
B — Maintain hydration and low-purine diet
Rationale:
Adequate fluids help prevent uric acid crystals in joints.
Alcohol, red meat, or fluid restriction increase risk.
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.
Which diagnostic test confirms demyelination in Guillain-Barré syndrome?
A. CT scan
B. Electroencephalogram
C. Electromyography (EMG)
D. Thyroid panel
Answer: C
Rationale: EMG and nerve conduction studies show slowed nerve conduction, confirming peripheral demyelination.
The nurse is teaching a client with Crohn’s disease about preventing flare-ups. Which statement indicates correct understanding?
A. “I will avoid NSAIDs when possible.”
B. “I should increase fiber during flare-ups.”
C. “I will drink one glass of water a day to avoid bloating.”
D. “I’ll stop my immunosuppressants if I feel better.”
A — Avoid NSAIDs
NSAIDs trigger Crohn’s flares.
(Other options are incorrect and dangerous.)
Which lab finding suggests improved kidney function in a client with lupus nephritis under treatment?
A. Urine protein decreasing from 4+ to 1+
B. Creatinine rising from 1.2 to 2.0 mg/dL
C. C3/C4 complement levels dropping further
D. BUN increasing from 18 to 32 mg/dL
A — Urine protein decreasing from 4+ to 1+
Rationale:
Reduced proteinuria = improved renal function and treatment response.
Rising creatinine, decreasing complements, or rising BUN = worsening disease.
A client with MS complains of muscle spasticity in the lower extremities interfering with walking. Which is the most appropriate initial nursing intervention?
A. Encourage high-intensity exercise
B. Administer prescribed baclofen and assess effectiveness
C. Apply heat packs continuously
D. Encourage prolonged bed rest
Answer: B — Administer baclofen and assess effectiveness
Rationale:
Baclofen = first-line for spasticity
Heat or exercise may help, but medication management and assessment is priority
Bed rest worsens spasticity.
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
The answer is A.
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.
A client experiencing an acute gout flare is prescribed colchicine. Which statement is correct?
A. Colchicine prevents future attacks but does not relieve acute pain.
B. Colchicine is used to reduce inflammation during an acute flare.
C. Colchicine increases uric acid excretion immediately.
D. Colchicine is used only in combination with allopurinol.
B — Colchicine is used to reduce inflammation during an acute flare
Rationale:
Colchicine = anti-inflammatory for acute attacks.
It does not lower uric acid, which is done by allopurinol.
Can be used alone during flare; not only in combination.
A client with RA is at risk for Sjogren’s syndrome. Which finding is consistent with this complication?
A. Cold fingers turning white and blue
B. Dry mouth and gritty feeling in the eyes
C. Widespread muscle pain and tender points
D. Butterfly rash on cheeks and nose
B. Dry eyes and dry mouth
Sjogren’s syndrome commonly accompanies RA.
A client with Guillain-Barré syndrome reports increasing numbness in the hands and new difficulty holding utensils. Which complication is the nurse MOST concerned about?
A. Hyperreflexia
B. Worsening ascending paralysis
C. Cerebral edema
D. Autonomic bradycardia
Answer: B
Rationale: New upper-extremity weakness is a sign the paralysis is ascending, meaning the disease is still progressing and can soon affect respiratory muscles.
A client with Crohn’s disease has been receiving infliximab infusions every 8 weeks. Which assessment finding requires the nurse to immediately notify the provider?
A. Mild fatigue after the infusion
B. Positive PPD (TB test)
C. Reports of mild headache
D. Occasional constipation
B. A positive PPD is a red flag that infliximab could reactivate TB and lead to life-threatening infection.
That’s why it must be reported immediately.
A patient is undergoing testing for the evaluation of Systemic Lupus Erythematous. What lab findings below are associated with this condition? Select 3 that apply:
A. Decreased ESR and CRP
B. Positive ANA
C. Positive Anti-dsDNA
D. Negative Anti-Sm
E. Low C3 and C4
The answers are B, C, and E.
A positive ANA demonstrates there are autoantibodies the body created against the nuclei of the dying cells (almost all patient with lupus will have a positive ANA), but these anti-nuclear antibodies can also be present with other autoimmune disorders.
A positive anti-dsDNA (anti-double stranded DNA anti-body) is a particular anti-nuclear antibody found in some patients with lupus and is not typically present in patients who don’t have lupus.
An INCREASE in ESR and CRP would be found in a patient with lupus (especially during a flare) along with a POSITIVE Anti-Sm antibody (which is a particular antibody found in the nucleus that is present in lupus).
A client with MS is prescribed interferon beta-1b. Which side effect should the nurse monitor for?
A. Flu-like symptoms (fever, chills, myalgia)
B. Permanent hair loss
C. Hypoglycemia
D. Bradycardia
Answer: A — Flu-like symptoms
Rationale:
Interferon beta often causes transient flu-like reactions
Hair loss, hypoglycemia, and bradycardia are not common with this medication.
A client with MG is receiving pyridostigmine 60 mg PO q4h. The client reports increased weakness, excessive salivation, nausea, and diarrhea 30 minutes after the dose. What should the nurse suspect?
A. Myasthenic crisis
B. Cholinergic crisis
C. Stroke
D. Infection
Answer: B — Cholinergic crisis
Rationale:
Cholinergic crisis = overdose of cholinesterase inhibitors.
Symptoms: muscle weakness, salivation, nausea, diarrhea, miosis.
Myasthenic crisis = weakness without cholinergic signs.
Immediate withholding medication and notifying provider is priority.
Which are common triggers for gout attacks? (Select 4)
A. Alcohol consumption, especially beer
B. High-purine foods like organ meats and shellfish
C. Trauma or surgery
D. Prolonged sun exposure
E. Dehydration
A, B, C, E
Rationale:
Gout triggers:
Alcohol (esp. beer)
High-purine foods
Trauma, surgery, stress
Dehydration
Sun exposure is not a gout trigger.
A provider prescribes hydroxychloroquine for a client with RA. What is the most important patient teaching?
A. “You must get an eye exam every 6–12 months.”
B. “Avoid foods high in purines.”
C. “Expect your urine to turn bright yellow.”
D. “Take this medication only during flare-ups.”
A.
A — Eye exams
Hydroxychloroquine can cause retinal damage.
A client with GBS suddenly develops difficulty taking deep breaths. Which action is priority?
A. Offer an incentive spirometer
B. Check vital signs
C. Prepare for possible intubation
D. Increase IV fluids
Answer: C
Rationale: The biggest risk in GBS is respiratory muscle paralysis. A sudden drop in respiratory effort requires rapid airway preparation because decline can be quick.
A client with Crohn’s disease receiving azathioprine reports new onset persistent sore throat and fever. Labs show:
WBC: 2,100/mm³
Neutrophils: 35%
Hgb: 12.8
Platelets: 250,000
Which action is priority?
A. Encourage oral hydration
B. Hold the next dose and place the client on neutropenic precautions
C. Administer PRN acetaminophen
D. Ask about recent sick contacts
1. B — Hold the azathioprine & implement neutropenic precautions.
Azathioprine → bone marrow suppression → neutropenia + infection risk.
Fever + low WBC = life-threatening infection risk.
A 28-year-old female with SLE presents with fever, malaise, and worsening joint pain. Labs show: WBC 2,200/mm³, neutrophils 30%, Hgb 10.2 g/dL, platelets 120,000. She is currently taking methotrexate and prednisone. What is the priority nursing action?
A. Encourage rest and fluids
B. Administer acetaminophen for fever
C. Notify the provider for possible infection
D. Teach about energy conservation
C — Notify the provider for possible infection
Rationale:
WBC 2,200 and neutrophils 30% = neutropenia
Patient is on methotrexate + prednisone → immunosuppressed
Fever + malaise = possible serious infection → priority is to notify provider
Rest, acetaminophen, teaching are important but secondary.
A 42-year-old client with MS is admitted for exacerbation. Symptoms: double vision, lower extremity weakness, fatigue, urinary retention. Medications: interferon beta-1a, baclofen. Which nursing action is priority?
A. Encourage ambulation to prevent stiffness
B. Assess bladder distention and initiate catheterization if needed
C. Administer baclofen and document spasticity
D. Schedule rest periods
Answer: B — Assess bladder distention
Rationale:
Urinary retention → risk of infection, kidney injury → priority
Spasticity, ambulation, and rest are secondary.
A client with MG in the ICU is receiving IVIG therapy. Which nursing interventions are priority during infusion?
A. Monitor vital signs every 15–30 min and assess for headache, hypotension, and anaphylaxis
B. Encourage ambulation during infusion
C. Limit fluids to prevent overload
D. Administer pyridostigmine immediately after infusion only
Answer: A — Monitor vital signs and assess for infusion reactions
Rationale:
IVIG can cause anaphylaxis, hypotension, headache, and renal impairment.
Frequent monitoring during infusion is critical for patient safety.
Ambulation is unsafe; fluid restriction or pyridostigmine timing is secondary.
A client with tophi on the elbows and fingers asks about treatment. Which is the best response?
A. “Tophi will resolve immediately with NSAIDs.”
B. “Allopurinol or febuxostat can gradually reduce tophi over time.”
C. “Colchicine will dissolve the tophi in a few days.”
D. “Tophi cannot be treated and must be surgically removed in all cases.”
B — “Allopurinol or febuxostat can gradually reduce tophi over time.”
Rationale:
Tophi are uric acid crystal deposits; lowering uric acid levels gradually dissolves them.
NSAIDs or colchicine treat inflammation, not tophi directly.
Which nursing interventions are appropriate during an acute RA exacerbation? select 4
A. Apply cold packs to inflamed joints
B. Encourage weight-bearing exercise
C. Support painful joints with splints
D. Provide warm paraffin baths
E. Promote frequent rest periods
F. Massage joints vigorously to improve mobility
A, C, D, E
Cold packs → reduce inflammation
Splinting → rest joints
Warm paraffin → muscle relaxation (NOT during acute red-hot inflammation)
Rest periods → reduce fatigue and inflammation
A client with GBS is 5 days post-onset and receiving IVIG. The nurse notes new bilateral facial weakness and drooling. What is the PRIORITY action?
A. Suction oral secretions
B. Notify provider of worsening symptoms
C. Assess gag and swallow reflex
D. Apply oxygen at 2 L/min
Answer: C
Rationale:
New facial weakness + drooling = risk for loss of airway protection.
Before suctioning or notifying the provider, the nurse must assess gag and swallow reflex to determine risk of aspiration and need for intubation.
A patient with UC reports 10+ bloody stools/day, HR 132, BP 88/54, temp 100.8°F, and is extremely weak. They’re receiving IV fluids but urine output is 15 mL/hr.
Which order should the nurse anticipate next?
A. Oral mesalamine
B. Increase IV fluids to 150 mL/hr
C. Prepare for blood transfusion and possible colectomy
D. Encourage oral electrolyte replacement
C.
This client is unstable:
Tachycardic
Hypotensive
Bloody stools
Very low UOP
This is fulminant UC, possibly hemorrhagic → surgical emergency.
Which findings are consistent with SLE flare-ups? (select 5)
A. Fever
B. Joint pain/swelling
C. New malar rash
D. Hypotension without other symptoms
E. Photosensitivity
F. Alopecia
A, B, C, E, F
Rationale:
Fever, joint pain/swelling, malar rash, photosensitivity, alopecia = classic SLE flare
D (isolated hypotension) = not specific for flare
A 34-year-old client with relapsing-remitting multiple sclerosis (MS) reports sudden worsening of blurred vision, weakness in the lower extremities, and tingling in the hands after taking a hot shower and walking outside on a warm day. VS are stable. The client asks why these symptoms are happening.
Which nursing explanation and intervention is most appropriate?
A. “Your symptoms indicate a new MS exacerbation; we should start high-dose corticosteroids immediately.”
B. “These symptoms are a temporary worsening due to heat exposure, known as Uhthoff’s phenomenon; avoid overheating and monitor for return to baseline.”
C. “This is unrelated to your MS; these are signs of infection and require antibiotics.”
D. “You should increase activity to overcome fatigue and restore nerve function.”
B
Rationale:
Uhthoff’s phenomenon = transient worsening of MS symptoms triggered by increased body temperature (e.g., heat exposure, hot shower, fever, exercise).
Symptoms: blurred vision, weakness, numbness, tingling, often temporary and reversible once body cools.
This is not a new relapse or infection, so high-dose corticosteroids or antibiotics are not immediately indicated.
Nursing priorities:
Educate patient about triggers and avoidance strategies (cool environments, hydration, pacing activity).
Monitor symptoms and ensure they return to baseline.
Document and reassess; escalate only if symptoms persist beyond heat exposure or new neurological deficits appear.
Why other options are incorrect:
A: Starting corticosteroids is unnecessary — Uhthoff’s is temporary and not a true exacerbation.
C: Infection is not indicated; vital signs are stable and there are no systemic symptoms.
D: Increasing activity while overheated may worsen symptoms and is unsafe.
A client with MG presents with ptosis, dysphagia, generalized weakness, and shallow respirations. The nurse suspects myasthenic crisis. ABG results: pH 7.32, PaCO₂ 52 mmHg, PaO₂ 88 mmHg. Which action has the highest priority?
A. Administer pyridostigmine immediately
B. Prepare for possible ventilatory support and notify provider
C. Encourage oral fluids to strengthen muscles
D. Document and continue monitoring
Answer: B — Prepare for possible ventilatory support
Rationale:
ABG indicates respiratory acidosis → impending respiratory failure.
Airway and breathing take priority over medication administration.
Myasthenic crisis can be triggered by missed doses, infection, or stress.
A client is admitted for acute gout flare. He is diabetic and taking insulin. The provider prescribes high-dose prednisone for 5 days. Which nursing action is priority?
A. Monitor blood glucose closely
B. Encourage high-protein diet
C. Apply heat to the affected joint
D. Teach low-purine diet
A — Monitor blood glucose closely
Rationale:
High-dose prednisone → hyperglycemia, especially in diabetic patients.
Blood glucose monitoring is priority to prevent acute complications.
Diet teaching and joint interventions are secondary.
A client with long-standing RA on prednisone 15 mg daily arrives with new symptoms. Which finding is the highest priority?
A. Moon face and increased appetite
B. Blood glucose 230 mg/dL
C. Sudden lower back pain with difficulty urinating
D. Weight gain of 4 pounds over 2 weeks
Answer: C
Rationale:
Chronic steroid use → risk for vertebral compression fractures and adrenal crisis.
Acute back pain + urinary issues = possible spinal compression (emergent neurologic complication).
A & D: Expected steroid side effects
B: Hyperglycemia is expected & not emergent
A client with GBS reports feeling anxious before bedtime and asks for a sedative. Which medication order would require the nurse to question?
A. Lorazepam
B. Melatonin
C. Diphenhydramine
D. Low-dose trazodone
Answer: A
Rationale:
Sedatives like lorazepam can depress respiration, which is extremely dangerous in a patient at risk for respiratory muscle failure.
Safer options are non-respiratory depressants (melatonin, low-dose trazodone).