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A client is suspected to have Lyme disease and has a red macule at the site of the tick bite with a bull's-eye rash with round rings surrounding the center. In addition, the client has a severe headache with neck stiffness. What stage of Lyme disease does the nurse suspect?
- A. Early stage 1
- B. Mid-stage
- C. Later stage
- D. Latent stage
Correct Answer: A
Rationale: Early stage 1 symptoms for about one third of clients include a red macule or papule at the site of the tick bite, a characteristic bull's-eye rash (called erythema migrans) with round rings surrounding the center, severe headache, and neck stiffness. Mid-stage and later stage symptoms include more systemic involvement like joint pain or neurological symptoms, while the latent stage may be asymptomatic.
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The nurse is preparing a client for a surgical procedure that will allow visualization of the extent of joint damage of the knee for a client with rheumatoid arthritis and also obtain a sample of synovial fluid. What procedure will the nurse prepare the client for?
- A. Open reduction
- B. Needle aspiration
- C. Arthroplasty
- D. Arthroscopy
Correct Answer: D
Rationale: Arthroscopic examination may be carried out to visualize the extent of joint damage as well as to obtain a sample of synovial fluid. An open reduction would be used for the treatment of a fracture. Needle aspiration will not allow visualization of the joint damage but will allow obtaining the sample of synovial fluid. Arthroplasty is the restructure of the joint surface after diagnosis is made.
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.
The nurse is conducting a new-patient assessment on a patient who reports having fibromyalgia. Which of the following would the nurse expect to assess as the most common finding associated with this condition?
- A. Heberden nodes
- B. Jaw locking
- C. Widespread chronic pain
- D. Butterfly facial rash
Correct Answer: C
Rationale: The most common finding associated with fibromyalgia is widespread and chronic pain, as clients experience an increased sensitivity to pain signals. Heberden nodes are associated with osteoarthritis. Jaw locking is a manifestation of temporomandibular joint dislocation. A butterfly facial rash is associated with systemic lupus erythematosus.
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 with suspected osteomalacia has a fractured tibia and fibula. What test would give a definitive diagnosis of osteomalacia?
- A. A bone biopsy
- B. Demineralization of the bone
- C. Increased and decreased areas of bone metabolism
- D. Elevated levels of alkaline phosphatase
Correct Answer: A
Rationale: A definitive diagnosis is obtained by bone biopsy. Radiographic studies demonstrate demineralization of the bone. A bone scan detects increased and decreased areas of bone metabolism. Alkaline phosphatase levels are detected from a blood sample.