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A client has been having joint pain and swelling in the left foot and is diagnosed with rheumatoid arthritis. The symptoms began suddenly without any identifiable cause, and the client has significant joint destruction. What type of disease is this considered?
- A. An exacerbation of a previous disorder
- B. Autoimmune
- C. An alloimmunity disorder
- D. A cause-and-effect relationship
Correct Answer: B
Rationale: Diseases are considered autoimmune disorders when they are characterized by unrelenting, progressive tissue damage without any verifiable etiology. The client did not have a previous disorder that has caused an exacerbation. An alloimmunity describes an immune response that is waged against transplanted organs and tissues that carry non self antigens. Because there is no identifiable cause, there can be no effect.
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A client comes to the clinic and reports having had a mild case of the flu a couple of months ago and not having felt well since. The client expresses feeling fatigued that gets worse after any physical activity and having a recurrent sore throat and joint pain. What does the nurse recognize these symptoms may indicate?
- A. Chronic fatigue syndrome
- B. Rheumatoid arthritis
- C. Ulcerative colitis
- D. Recurrent flu
Correct Answer: A
Rationale: Many clients with CFS report having had a recent illness with flulike symptoms or an upper respiratory infection. Despite having been uncomfortable, most clients do not describe their initial symptoms as being extraordinarily severe. Severe, ongoing fatigue lasts for at least 6 months without any explanation. Even though the fatigue is constant, it worsens after physical activity. The fatigue is so debilitating that it usually interferes with a person's ability to work in or outside the home. Rheumatoid arthritis and ulcerative colitis are autoimmune disorders with symptoms that are more specific than CFS and can be diagnosed with diagnostic testing and laboratory studies. The symptoms that the client is having are not characteristic of the flu.
A client has an allergic reaction to seafood with generalized edema and reports being unable to get a wedding ring off as it is too tight. The client was unable to remove it with soap and water. What action by the nurse can facilitate removal of the ring without damaging it?
- A. Administer a diuretic and wait for the swelling to go down.
- B. There is not another option other than to use a ring cutter to remove the ring.
- C. Use twine to wrap the finger and, when the tissue is compressed, pull the free end of the twine and remove the ring.
- D. Use a tongue blade to remove the ring.
Correct Answer: C
Rationale: If applying soap or oil to the finger proves unsuccessful, the nurse may wrap the finger with twine. Once the tissue is compressed, the ring can be removed by pulling on the free end of the twine. This technique is preferable to damaging the ring with a metal cutter. If nothing else facilitates ring removal, however, cutting the ring is a better option than allowing damage from ischemia to develop. The nurse cannot administer a diuretic without a physician's prescription, and allowing the swelling to go down may cause tissue ischemia from the constricted ring. There are options other than cutting the ring, but if they fail, there is no other choice. A tongue blade will not remove a ring that is too tight.
A client with lupus has had antineoplastic drugs prescribed. Why would the physician prescribe antineoplastic drugs for an autoimmune disorder?
- A. To decrease the body's risk of infection
- B. Because an autoimmune disease is a neoplastic disease.
- C. So the client has strong drug therapy
- D. For their immunosuppressant effects
Correct Answer: D
Rationale: Drug therapy using anti-inflammatory and immunosuppressive agents is the mainstay for alleviating symptoms. Some antineoplastic (cancer) drugs also are used for their immunosuppressant effects. Antineoplastic drugs do not decrease the body's risk of infection; an autoimmune disease is not a neoplastic disease. Drugs are not prescribed just so the client has strong drug therapy.
The nurse has four clients who are scheduled to see the physician for 'fatigue' and other general symptom complaints. Which client does the nurse determine is at most risk for having chronic fatigue syndrome?
- A. Male of Hispanic descent, age 28 years
- B. Female of Caucasian descent, age 47 years
- C. Female of African descent, age 42 years
- D. Female of Chinese descent, age 18 years
Correct Answer: B
Rationale: Estimates are that as many as 4 million people in the United States have symptoms corresponding with chronic fatigue syndrome, but fewer than 80% have been diagnosed by a medical provider. Most clients who seek treatment for their symptoms are Caucasian women 40 to 59 years of age. CFS also occurs at lower rates among children, adolescents, and men.
The nurse is talking with a client who was stung by a bee and began having difficulty breathing. What serious complication from injected venom should the nurse discuss with the client?
- A. Hives
- B. Itching
- C. Airway obstruction
- D. Diarrhea
Correct Answer: C
Rationale: Injectants, such as bee venom, and some other allergens can produce systemic and potentially fatal effects, including shock and airway obstruction caused by laryngeal swelling. Although all other answers can occur with an allergen, they are not the most serious complication.