ANYTHING
A woman who has multiple sclerosis (MS) asks the nurse about risks associated with pregnancy. Which response would the nurse provide?
a. “MS symptoms will be worse after the pregnancy.” b. “Symptoms of MS may improve during pregnancy.” c. “Women with MS frequently have premature labor.”
d. “MS is associated with an increased risk for congenital defects.”
ANS: B Some women with MS have remission or an improvement in symptoms during pregnancy. Symptoms of MS may improve during pregnancy. There is no increased risk for congenital defects in infants born of mothers with MS. Onset of labor is not affected by MS. MS symptoms will not worsen after pregnancy.
Which action would the nurse include in the plan of care for a patient with a new diagnosis of rheumatoid arthritis (RA)?
a. Instruct the patient to purchase a soft mattress.
b. Teach the patient to use cool water when bathing. c. Encourage the patient to take a nap in the afternoon.
d. Suggest exercise with light weights several times daily
ANS: C Adequate rest helps decrease the fatigue and pain associated with RA. Patients are taught to avoid stressing joints, use warm baths to relieve stiffness, and use a firm mattress. When the disease is stabilized, a physical therapist usually develops a therapeutic exercise program that includes exercises that improve flexibility and strength of affected joints, as well as the patient‘s general endurance.
Which finding for a patient who is taking hydroxychloroquine (Plaquenil) to treat rheumatoid arthritis would the nurse identify as a likely adverse effect of the medication?
a. Blurred vision
b. Joint tenderness
c. Abdominal cramping
d. Elevated blood pressure
ANS: A Plaquenil can cause retinopathy. The medication should be stopped. Other findings are not related to the medication although they will also be reported.
Which finding for a patient admitted with glomerulonephritis indicates to the nurse that treatment has been effective?
a. The urine dipstick is negative for nitrites.
b. The patient denies pain or burning with voiding.
c. The antistreptolysin-O (ASO) titer has decreased.
d. The periorbital and peripheral edema have resolved.
ANS: D Because edema is a common clinical manifestation of glomerulonephritis, resolution of the edema indicates that the prescribed therapies have been effective. Nitrites will be negative, and the patient will not experience dysuria because the patient does not have a urinary tract infection. Antibodies to streptococcus will persist after a streptococcal infection.
What laboratory value would the nurse check before administering captopril to a patient with stage 2 chronic kidney disease?
a. Glucose
b. Potassium
c. Creatinine
d. Phosphate
ANS: B Angiotensin-converting enzyme (ACE) inhibitors are often used in patients with CKD because they delay the progression of the CKD, but they cause potassium retention. Therefore, careful monitoring of potassium levels is needed in patients who are at risk for hyperkalemia. The other laboratory values would also be monitored in patients with CKD but would not affect administration of captopril.
Which action would the nurse plan to take for a patient with multiple sclerosis who has urinary retention caused by a flaccid bladder?
a. Teach the patient how to self-catheterize.
b. Encourage decreased evening fluid intake.
c. Suggest the use of adult incontinence briefs.
d. Assist the patient to the commode every 2 hours.
ANS: A The patient may need to intermittently self-catheterize when urinary retention is not relieved by other means. Decreasing fluid intake will not improve bladder emptying and may increase risk for urinary tract infection and dehydration. The use of incontinence briefs and frequent toileting will not improve bladder emptying.
Which statement by a patient with systemic lupus erythematosus (SLE) indicates the patient understands the nurse‘s teaching about the condition?
a. “I will exercise even if I am tired.”
b. “I will use sunscreen when I am outside.”
c. “I should avoid nonsteroidal antiinflammatory drugs.”
d. “I should take birth control pills to avoid getting pregnant.”
ANS: B Severe skin reactions can occur in patients with SLE who are exposed to the sun. Patients would avoid fatigue by balancing exercise with rest periods as needed. Oral contraceptives can exacerbate lupus. Aspirin and nonsteroidal antiinflammatory drugs are used to treat the musculoskeletal manifestations of SLE.
A 68-yr-old patient admitted to the hospital with dehydration is confused and incontinent of urine. Which action would the nurse include in the plan of care?
a. Restrict fluids between meals and after the evening meal.
b. Insert an indwelling catheter until the symptoms have resolved.
c. Assist the patient to the bathroom every 2 hours during the day.
d. Apply absorbent adult incontinence diapers and pads over the bed linens.
ANS: C In older or confused patients, incontinence may be avoided by using scheduled toileting times. Indwelling catheters increase the risk for urinary tract infection. Incontinent pads and diapers increase the risk for skin breakdown. Restricting fluids is not appropriate in a patient with dehydration.
The nurse is planning care for a patient with severe heart failure who has developed increased blood urea nitrogen (BUN) and creatinine levels. Which aim will be the primary treatment goal?
a. Augmenting fluid volume
b. Maintaining cardiac output
c. Diluting nephrotoxic substances
d. Preventing systemic hypertension
ANS: B The primary goal of treatment for acute kidney injury (AKI) is to eliminate the cause and provide supportive care while the kidneys recover. Because this patient‘s heart failure is causing AKI, the care will be directed toward treatment of the heart failure. Renal failure caused by hypertension, hypovolemia, or nephrotoxins would be managed by interventions specific to those problems.
Which information would the nurse include when teaching a patient who has an exacerbation of rheumatoid arthritis?
a. Affected joints should not be exercised when pain is present.
b. Applying cold packs before exercise may decrease joint pain.
c. Exercises should be performed passively by someone other than the patient.
d. Walking may substitute for range-of-motion (ROM) exercises on some days.
ANS: B Cold application is helpful in reducing pain during periods of RA exacerbation. Because the joint pain is chronic, patients are instructed to exercise even when joints are painful. ROM exercises are intended to strengthen joints and improve flexibility, so passive ROM alone is not sufficient. Recreational exercise is encouraged but is not a replacement for ROM exercises.
A patient with Parkinson‘s disease (PD) has bradykinesia. Which action would the nurse include in the plan of care?
a. Instruct the patient in activities that can be done while lying or sitting.
b. Suggest that the patient use the arms of the chair to help push up to standing.
c. Have the patient take small steps in a straight line directly in front of the feet.
d. Teach the patient to keep the feet in contact with the floor and slide them forward.
ANS: B Pushing down on the arms of the chair and placing the back legs of the chair on small (2-inch) blocks help the individual with PD to stand. The patient will be encouraged to continue exercising because this will maintain functional abilities. Maintaining a wider base of support, rather than stepping directly forward, will help with balance. The patient should lift the feet and avoid a shuffling gait.
Which information in the patient history would indicate a possible cause of acute glomerulonephritis?
a. Recent bladder infection
b. History of kidney stones
c. Recent sore throat and fever
d. History of high blood pressure
ANS: C Acute glomerulonephritis frequently occurs after a streptococcal infection such as strep throat. It is not caused by kidney stones, hypertension, or urinary tract infection.
Which finding for a patient who has just been admitted with acute pyelonephritis is most important for the nurse to report to the health care provider?
a. Flank tenderness to palpation
b. Blood pressure 90/48 mm Hg
c. Cloudy and foul-smelling urine
d. Temperature 100.1F
ANS: B The low blood pressure indicates that urosepsis and septic shock may be occurring and would be immediately reported. The other findings are typical of pyelonephritis.
A 25-yr-old female patient with systemic lupus erythematosus (SLE) has a facial rash and alopecia. She tells the nurse, “I never leave my house because I hate the way I look.” Which patient problem would the nurse plan to address?
a. Activity intolerance
b. Impaired socialization
c. Impaired tissue integrity
d. Impaired communication
ANS: B The patient‘s statement about not going anywhere because of hating the way he or she looks expresses impaired socialization, an insufficient quantity of human Interaction, because of embarrassment about the effects of the SLE. Activity intolerance is a possible problem for patients with SLE, but the information about this patient does not support this. The rash with SLE does not impair tissue integrity. There is no evidence of impaired communication ability for this patient.
A female patient with chronic kidney disease (CKD) is receiving peritoneal dialysis with 2-L inflows. Which information would the nurse report promptly to the health care provider?
a. The patient has an outflow volume of 1800 mL.
b. The patient‘s peritoneal effluent appears cloudy.
c. The patient‘s abdomen appears bloated after the inflow.
d. The patient has abdominal pain during the inflow phase.
ANS: B Cloudy-appearing peritoneal effluent is a sign of possible peritonitis and would be reported immediately so that treatment with antibiotics can be started. The other problems can be addressed through nursing interventions such as slowing the inflow and repositioning the patient.
Which recommendation would the nurse provide to a patient with myasthenia gravis (MG)?
a. Anticipate the need for weekly plasmapheresis treatments.
b. Complete physically demanding activities early in the day.
c. Protect the extremities from injury due to poor sensory perception.
d. Perform frequent weight-bearing exercise to prevent muscle atrophy.
ANS: B Muscles are generally strongest in the morning, and muscle weakness is prominent by the end of the day, so activities involving muscle activity should be scheduled early. Plasmapheresis is not routinely scheduled but is used for myasthenia crisis or for situations in which corticosteroid therapy must be avoided. There is no decrease in sensation with MG. Muscle atrophy does not occur because although muscles are weak, they are still used.
A patient has had recurrent uric acid kidney stones. Which diet items would the nurse recommend that the patient avoid or limit?
a. Milk and cheese
b. Sardines and liver
c. Spinach and chocolate
d. Legumes and dried fruit
ANS: B Organ meats and fish such as sardines increase purine levels and uric acid. Spinach, chocolate, and tomatoes should be avoided in patients who have oxalate stones. Milk, dairy products, legumes, and dried fruits may increase the incidence of calcium-containing stones.
Which suggestion would the nurse make to a group of women with rheumatoid arthritis (RA) about managing activities of daily living?
a. Strengthen small hand muscles by wringing out sponges or washcloths.
b. Protect the knee joints by sleeping with a small pillow under both knees.
c. Stand rather than sit when performing daily household and yard chores.
d. Limit the number of exercise repetitions during periods of acute inflammation.
ANS: D Patients are advised to avoid repetitious movements and exercises during periods of acute inflammation. Sitting during household chores is recommended to decrease stress on joints. Wringing water out of sponges would increase joint stress. Patients are encouraged to position joints in the extended (neutral) position; sleeping with a pillow behind the knees would decrease the ability of the knee to extend.
A patient who has acute glomerulonephritis is hospitalized with hyperkalemia. Which information will the nurse monitor to evaluate the effectiveness of the prescribed calcium gluconate IV?
a. Urine volume
b. Calcium level
c. Cardiac rhythm
d. Neurologic status
ANS: C Calcium gluconate raises the threshold at which dysrhythmias occur, temporarily stabilizing the myocardium. The nurse will monitor the other data as well, but these will not be helpful in determining the effectiveness of the calcium gluconate.
A 74-yr-old patient who is progressing to stage 5 chronic kidney disease asks the nurse, “Do you think I would go on dialysis?” Which initial response would the nurse provide?
a. “It depends on which type of dialysis you are considering.”
b. “Tell me more about what you are thinking regarding dialysis.”
c. “You are the only one who can make the decision about dialysis.”
d. “Many people your age use dialysis and have a good quality of life.”
ANS: B The nurse would initially clarify the patient‘s concerns and questions about dialysis. The patient is the one responsible for the decision, and many people using dialysis do have good quality of life, but these responses block further assessment of the patient‘s concerns. Referring to which type of dialysis the patient might use only indirectly responds to the patient‘s question.
A 74-yr-old patient is seen in the health clinic with new development of a stooped posture, shuffling gait, and pill rolling–type tremor. Which topic would the nurse anticipate explaining to the patient?
a. Oral corticosteroids
b. Dopaminergic drugs
c. Magnetic resonance imaging (MRI)
d. Electroencephalogram (EEG) testing
ANS: B The clinical diagnosis of Parkinson‘s is made when tremor, rigidity, akinesia, and postural instability are present. The confirmation of the diagnosis is made on the basis of improvement when dopaminergic drugs are administered. MRI and EEG are not useful in diagnosing Parkinson‘s disease, and corticosteroid therapy is not used to treat it.
Which result for a patient with systemic lupus erythematosus (SLE) would the nurse identify as most important to communicate to the health care provider?
a. Decreased C-reactive protein (CRP)
b. Elevated blood urea nitrogen (BUN)
c. Positive antinuclear antibodies (ANA)
d. Positive lupus erythematosus cell prep
ANS: B Elevated BUN and serum creatinine indicate possible lupus nephritis and a need for a change in therapy to avoid further renal damage. The positive lupus erythematosus cell prep and ANA would be expected in a patient with SLE. A drop in CRP shows decreased inflammation.
A 76-yr-old with benign prostatic hyperplasia (BPH) is agitated and confused, with a markedly distended bladder. Which intervention prescribed by the health care provider would the nurse implement first?
a. Insert an indwelling urinary catheter.
b. Draw blood for a serum creatinine level.
c. Schedule an intravenous pyelogram (IVP).
d. Administer lorazepam (Ativan) 0.5 mg PO.
ANS: A The patient‘s history and clinical manifestations are consistent with acute urinary retention, and the priority action is to relieve the retention by catheterization. The BUN and creatinine measurements can be obtained after the catheter is inserted. The patient‘s agitation may resolve after the bladder distention is corrected, and sedative drugs would be used cautiously in older patients. The IVP may be done as a diagnostic test but does not need to be done urgently.
A licensed practical/vocational nurse (LPN/VN) is caring for a patient with stage 2 chronic kidney disease. Which observation by the RN requires an intervention?
a. The LPN/VN assists the patient to ambulate in the hallway.
b. The LPN/VN administers the erythropoietin subcutaneously.
c. The LPN/VN administers the iron supplement and phosphate binder with lunch.
d. The LPN/VN carries a tray containing low-protein foods into the patient‘s room.
ANS: C Oral phosphate binders would not be given at the same time as iron because they prevent the iron from being absorbed. The phosphate binder would be given with a meal and the iron given at a different time. The other actions by the LPN/VN are appropriate for a patient with renal insufficiency.
The health care provider has prescribed the following interventions for a patient who is taking azathioprine (Imuran) for systemic lupus erythematosus. Which order would the nurse question?
a. Draw anti-DNA blood titer.
b. Administer varicella vaccine.
c. Naproxen 200 mg twice daily.
d. Famotidine (Pepcid) 20 mg daily.
ANS: B Live virus vaccines, such as varicella, are contraindicated in a patient taking immunosuppressive drugs. The other orders are appropriate for the patient.