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The nurse is determining the type of arthritis a patient is experiencing. Which assessment finding would be present if the patient has rheumatoid arthritis?
- A. Stiffness is relieved by activity
- B. Health history includes weight loss and fever
- C. Abnormal joint findings are limited to the hands
- D. Heberden’s nodes are located on the finger joints
Correct Answer: B
Rationale: In rheumatoid arthritis, the health history often includes systemic symptoms such as weight loss and fever. Rheumatoid arthritis is a chronic inflammatory autoimmune disease that affects multiple joints symmetrically. Unlike osteoarthritis where joint stiffness is often relieved by activity, stiffness in rheumatoid arthritis is typically worse in the morning and after inactivity. In rheumatoid arthritis, joint deformities can occur in various joints, not just limited to the hands. Heberden's nodes are characteristic of osteoarthritis, not rheumatoid arthritis.
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The nurse is caring for a client with congestive heart failure (CHF) who frequently wakes during the night frightened and short of breath. Based on this data, what is the client experiencing?
- A. Cardiomyopathy
- B. Paroxysmal nocturnal dyspnea
- C. High-output failure
- D. Multisystem heart failure
Correct Answer: B
Rationale: Paroxysmal nocturnal dyspnea is a symptom commonly seen in patients with congestive heart failure (CHF). It is characterized by sudden awakening from sleep due to difficulty breathing and feeling of suffocation. This occurs because when the patient lies down, the redistribution of fluid in the body leads to increased fluid in the lungs, causing difficulty in breathing. Patients with CHF often experience worsening of symptoms at night, including paroxysmal nocturnal dyspnea, due to the shift in fluid dynamics in a supine position. Therefore, the client in this scenario is likely experiencing paroxysmal nocturnal dyspnea, a classic symptom of heart failure exacerbation.
What causes brown pigmentation of the lower extremities in clients with venous stasis?
- A. The necrosis of subcutaneous fat due to tissue hypoxia
- B. Breakdown of red blood cells in the congested tissues
- C. Reduced inflammatory and immune response from congested circulation
- D. Skin atrophy caused by lack of circulation
Correct Answer: B
Rationale: The brown pigmentation of the lower extremities in clients with venous stasis is primarily caused by the breakdown of red blood cells in the congested tissues. When there is venous stasis, the blood circulation is impaired, leading to a backup of blood in the lower extremities. This stagnant blood contains hemosiderin, a byproduct of red blood cell breakdown. Over time, the hemosiderin deposits in the tissues, causing the characteristic brown discoloration seen in conditions such as chronic venous insufficiency. This process is known as hemosiderin deposition and is a common consequence of venous stasis.
A nurse is working in a neonatal intensive care unit (NICU). The nurse wants to teach a mother of a premature baby how to give her baby a bath. Which statement by the mother reflects a readiness to learn?
- A. "You'll give us written instructions before we go home, correct?"
- B. "When my baby is just a little bigger, I'll feel more comfortable giving him a bath."
- C. "I want to make sure my husband is here, in case I don't hear everything that's said."
- D. "I'm so afraid I'll hurt my baby with all these tubes and wires."
Correct Answer: A
Rationale: The statement "You'll give us written instructions before we go home, correct?" reflects the mother's readiness to learn. This statement shows that the mother is actively seeking out resources and tools to help her understand and remember the instructions for giving her premature baby a bath. It indicates that she is willing to take responsibility for her baby's care and is thinking ahead to ensure she has the necessary information for when she is on her own at home. This statement demonstrates engagement and a proactive approach to learning, which are essential for successfully caring for a premature baby in a NICU setting.
A client with primary hypertension is prescribed terazosin (Hytrin) to treat this condition. What is the mechanism of action of this drug?
- A. Prevents conversion of angiotensin I to angiotensin II
- B. Prevents beta-receptor stimulation in the heart
- C. Inhibits the flow of calcium ions across the cell membrane of vascular tissue and cardiac cells
- D. Blocks alpha-receptors in the vascular smooth muscle
Correct Answer: D
Rationale: Terazosin is an alpha-1 adrenergic receptor blocker. By blocking alpha-1 receptors in the vascular smooth muscle, terazosin causes dilation of both arteries and veins, leading to reduced peripheral vascular resistance and decreased blood pressure. This dilation effect is achieved by preventing the binding of norepinephrine to alpha-1 receptors, thereby inhibiting vasoconstriction. Terazosin is commonly used in the treatment of hypertension to help lower blood pressure by reducing the workload on the heart and improving blood flow to organs and tissues.
The nurse is planning discharge teaching to a client with diabetes who has a large wound. Which is the priority action for the nurse prior to initiating teaching with this client?
- A. Asking the client to state what is known about the current dressing changes
- B. Teaching the client how to take blood sugars
- C. Assessing the client's ability to self-administer insulin
- D. Determining the client's reaction to having diabetes
Correct Answer: A
Rationale: The priority action for the nurse before initiating discharge teaching with a client with diabetes and a large wound is to assess the client's current knowledge regarding dressing changes. This step is crucial as it helps the nurse to understand the client's baseline understanding and skills related to wound care, which will guide the teaching process effectively. By asking the client to state what they know about the current dressing changes, the nurse can identify any knowledge gaps or misconceptions that need to be addressed. This assessment will ensure that the teaching is tailored to the client's specific needs and promotes successful wound healing and overall diabetes management.