Nokea
On a visit to the clinic, a client reports the onset of early symptoms of rheumatoid arthritis. The nurse should conduct a focused assessment for:
- A. Limited motion of joints.
- B. Deformed joints of the hands.
- C. Early morning stiffness.
- D. Rheumatoid nodules.
Correct Answer: C
Rationale: Early morning stiffness is a hallmark symptom of rheumatoid arthritis, especially in the early stages, as it reflects joint inflammation that worsens after periods of inactivity.
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Which of the following statements is most accurate regarding the long-term toxic effects of cancer treatments on the immune system?
- A. Clients with persistent immunologic abnormalities after treatment are at a much greater risk for infection than clients with a history of splenectomy.
- B. The use of radiation and combination chemotherapy can result in more frequent and more severe immune system impairment.
- C. Long-term immunologic effects have been studied only in clients with breast and lung cancer.
- D. The helper T cells recover more rapidly than the suppressor T cells, which results in positive helper cell balance that can last 5 years.
Correct Answer: B
Rationale: Radiation and combination chemotherapy can cause significant and prolonged immune suppression, increasing infection risk, which is a well-documented long-term effect.
The nurse is caring for a client with herpes simplex virus who is experiencing an outbreak. Which medication does the nurse anticipate that the primary healthcare provider (PHCP) will prescribe?
- A. metronidazole
- B. valacyclovir
- C. imiquimod
- D. fluconazole
Correct Answer: B
Rationale: Valacyclovir is an antiviral medication used to treat herpes simplex virus (HSV) outbreaks. Choice A (metronidazole) is for bacterial/parasitic infections, Choice C (imiquimod) is for genital warts, and Choice D (fluconazole) is for fungal infections.
A 68-year-old male has been receiving monthly doses of chemotherapy for treatment of stage III colon cancer. He comes to the clinic for his fourth monthly dose. Which laboratory result(s) should be reported to the oncologist before the next dose of chemotherapy is administered? Select all that apply.
- A. Hemoglobin of 14.5 g/dL.
- B. Platelet count of 40,000/mm³.
- C. Blood urea nitrogen (BUN) level of 12 mg/dL.
- D. White blood cell count of 2,300/mm³.
- E. Temperature of 101.2°F (38.4°C).
- F. Urine specific gravity of 1.020.
Correct Answer: B,D,E
Rationale: Low platelet count (B), low white blood cell count (D), and fever (E) indicate thrombocytopenia, neutropenia, and possible infection, respectively, which are contraindications for chemotherapy due to increased risk of bleeding and infection.
A client with acute renal failure reports shortness of breath. The nurse should:
- A. Administer oxygen.
- B. Increase fluid intake.
- C. Check lung sounds.
- D. Encourage coughing.
Correct Answer: C
Rationale: Shortness of breath may indicate fluid overload; lung sounds assess for pulmonary edema.
A client has returned to the medical surgical unit after having surgery to create an ileostomy. Which goal has the highest priority at this time?
- A. Providing relief from constipation.
- B. Assisting the client with self-care activities.
- C. Maintaining fluid and electrolyte balance.
- D. Minimizing odor formation.
Correct Answer: C
Rationale: Maintaining fluid and electrolyte balance is the highest priority post-ileostomy due to the risk of dehydration from high-output ileostomy effluent. Constipation is not a concern, and self-care or odor control are secondary to physiological stability. CN: Physiological adaptation; CL: Synthesize