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A client is complaining of severe pain in the left great toe. What lab studies that the nurse reviews indicate that the client may have gout?
- A. Elevated white blood count
- B. Elevated uric acid levels
- C. Decreased hemoglobin and hematocrit
- D. Increased AST and ALT
Correct Answer: B
Rationale: Gout is characterized by hyperuricemia (accumulation of uric acid in the blood) caused by alterations in uric acid production, excretion, or both. An elevated white blood count may indicate bleeding from somewhere in the body. Increased AST and ALT would indicate liver dysfunction.
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A client diagnosed with degenerative joint disease of the fingers reports now having bumps on the fingers that do not hurt. The nurse observes bony nodules on the distal interphalangeal joints. What type of 'bumps' does the nurse understand these are?
- A. Rheumatoid nodules
- B. Tophi
- C. Bouchard nodes
- D. Heberden nodes
Correct Answer: D
Rationale: DJD affects the hands; the fingers frequently develop painless bony nodules on the dorsolateral surface of the interphalangeal joints. Heberden nodes are bony enlargement of the distal interphalangeal joints. Bouchard nodes are bony enlargement of the proximal interphalangeal joints. Rheumatoid nodules are associated with rheumatoid arthritis. Tophi occur with gout and elevated uric acid levels.
The nurse is reviewing the diagnostic test findings of a client with rheumatoid arthritis. What would the nurse expect to find?
- A. Increased red blood cell count
- B. Increased C4 complement
- C. Elevated erythrocyte sedimentation rate
- D. Increased albumin levels
Correct Answer: C
Rationale: The erythrocyte sedimentation rate (ESR) may be elevated, particularly as the disease progresses. ESR shows inflammation associated with RA. Red blood cell count and C4 complement component are decreased. Serum protein electrophoresis may disclose increased levels of gamma and alpha globulin but decreased albumin.
A client has been diagnosed with temporomandibular disorder and has not been able to eat. What is an appropriate action for the nurse to take?
- A. Have the client's food pureed
- B. Have the client placed on a liquid diet.
- C. Have the client eat soft rather than coarse food.
- D. Give the client clear liquids as well as intravenous fluids.
Correct Answer: C
Rationale: The nurse modifies the diet to include soft rather than coarse food, which is easier to chew. The nurse also provides nutritional liquid supplements and assists the client to acquire skills that control pain, such as using a bite guard during sleep. The client does not require pureed food or clear liquids. Pureed and clear liquids are not warranted because these are too extreme and may interfere with nutrition.
A client has had several diagnostic tests to determine systemic lupus erythematosus (SLE). What result is very specific indicator of this diagnosis?
- A. Positive Anti-dsDNA antibody test
- B. Positive Anti-Sm antibodies
- C. Positive ANA titer
- D. Elevated ESR
Correct Answer: A
Rationale: Anti-double-stranded DNA (anti-dsDNA) antibody test is a test that shows high titers of antibodies against native DNA. This is very specific for SLE because this test is not positive for other autoimmune disorders. Anti-Smith (anti-Sm) antibodies are specific for SLE, but are found in only 20% to 30% of clients with SLE. ANA titer shows the presence of an autoimmune disease but is not specific to SLE. The other lab studies may also indicate multisystem involvement.
A client with ankylosing spondylitis has a stooped position and is being positioned in the bed prior to the nurse taking vital signs. The nurse listens to the client's lungs after positioning. What finding related to the client's condition may the nurse hear when listening to lung sounds?
- A. Crackles in the bases
- B. Pericardial friction rub
- C. Lung sounds may be diminished in the apical area.
- D. Rhonchi
Correct Answer: C
Rationale: Lung sounds may be reduced, especially in the apical area. The nurse would not hear rhonchi, crackles, or a pericardial friction rub unless the client had underlying cardiac or respiratory disorders.