Nokea
A nurse is monitoring a client diagnosed with Lyme disease. Which finding would suggest that the disease is in the early stages?
- A. Breathlessness
- B. Red macule or papule
- C. Bony nodule
- D. Swollen painful knees
Correct Answer: B
Rationale: Early stage 1 symptoms include a red macule or papule at the site of the tick bite, a typical bull's-eye rash, headache, neck stiffness, and pain. Breathlessness and bony nodules are not associated with Lyme disease. Later stage symptoms include swollen and painful knees.
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A client suffered a significant ankle fracture several months ago. Which indicator would the nurse use to determine that the client is exhibiting signs and symptoms of chronic osteomyelitis?
- A. High fever
- B. Persistent draining sinus
- C. Rapid pulse
- D. Tenderness over the affected area
Correct Answer: B
Rationale: Persistent draining sinus indicates a chronic infection in a client with osteomyelitis. This is the symptom the nurse would use to differentiate between an acute and chronic infection. High fever, rapid pulse, and tenderness or pain over the affected area is evidence of an acute infection.
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.
A nurse is caring for a client with gout. Which of the following would the nurse encourage the client to limit?
- A. Fluid intake
- B. Protein-rich foods
- C. Purine-rich foods
- D. Carbohydrates
Correct Answer: C
Rationale: Clients with gout should be advised to have adequate protein with the limitation of purine-rich foods to avoid contributing to the underlying problem. The diet should also be relatively high in carbohydrates and low in fats because carbohydrates increase urate excretion and fats retard it. A high fluid intake is recommended because it helps increase the excretion of uric acid.
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.
A client is receiving treatment for an acute episode of gout with colchicine. The nurse is administering the medication every 2 hours. What symptom(s) should the nurse be sure the client communicates so that the drug can be temporarily stopped? Select all that apply.
- A. Diarrhea
- B. Tingling in the arms
- C. Intestinal cramping
- D. Increase in pain in the affected extremity
- E. Nausea and vomiting
Correct Answer: A,C,E
Rationale: Colchicine is administered every 1 or 2 hours until the pain subsides or nausea, vomiting, intestinal cramping, and diarrhea develop. When one or more of these symptoms occurs, the drug should be stopped temporarily. Tingling in the arms and increase in pain are not normal adverse reactions that are seen with this drug.