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The client diagnosed with RA who has been prescribed etanercept, a tumor necrosis factor alpha inhibitor, shows marked improvement. Which instruction regarding the use of this medication should the nurse teach?
- A. Explain the medication loses its efficacy after a few months.
- B. Continue to have checkups and laboratory work while taking the medication.
- C. Have yearly magnetic resonance imaging to follow the progress.
- D. Discuss the drug is taken for three (3) weeks and then stopped for a week.
Correct Answer: B
Rationale: Regular checkups and lab work monitor for etanercept side effects (e.g., infection). Efficacy persists, MRI is not routine, and cycling is incorrect.
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The nurse is admitting a client diagnosed with multiple sclerosis. Which clinical manifestation should the nurse assess? Select all that apply.
- A. Muscle flaccidity.
- B. Lethargy.
- C. Dysmetria.
- D. Fatigue.
- E. Dysphagia.
Correct Answer: C,D,E
Rationale: MS causes dysmetria (impaired coordination), fatigue, and dysphagia due to neurological damage. Muscle flaccidity is atypical (spasticity is common), and lethargy is non-specific.
The client comes to the emergency department complaining of dyspnea and wheezing after eating at a seafood restaurant. The client cannot speak and has a bluish color around the mouth. Which intervention should the nurse implement first?
- A. Initiate an IV with normal saline.
- B. Prepare to intubate the client.
- C. Administer oxygen at 100%.
- D. Ask the client about an iodine allergy.
Correct Answer: C
Rationale: Administering 100% oxygen addresses immediate hypoxia in anaphylaxis, per ABCs. IV fluids, intubation, and allergy history follow.
The client is diagnosed with Multi Organ Dysfunction Syndrome (MODS). Which is the most appropriate goal for the nurse to write when planning the client's care?
- A. The client will maintain vital signs within normal limits during the next 24 hours.
- B. The client's urine output will be maintained to achieve output of 600 mL in the next 24 hours.
- C. The client will have elevated ALT, AST, and GGT liver enzymes within the next 24 hours.
- D. The client's blood glucose reading will be 200 to 240 mg/dL for the next 24 hours.
Correct Answer: A
Rationale: Maintaining normal vital signs is a broad, achievable goal in MODS. Urine output is specific, elevated enzymes are undesirable, and high glucose is not a goal.
The nurse is caring for clients on a medical floor. Which client should be assessed first?
- A. The client diagnosed with SLE who is complaining of chest pain.
- B. The client diagnosed with MS who is complaining of pain at a '10.'
- C. The client diagnosed with myasthenia gravis who has dysphagia.
- D. The client diagnosed with GB syndrome who can barely move his toes.
Correct Answer: A
Rationale: Chest pain in SLE may indicate pericarditis or pleuritis, potentially life-threatening, requiring immediate assessment. Severe pain, dysphagia, and toe weakness are less acute.
Which intervention should the nurse implement for the client diagnosed with systemic sclerosis (scleroderma)?
- A. Instill artificial tears four (4) times a day.
- B. Apply moisturizers to the skin frequently.
- C. Instruct the client on how to apply braces.
- D. Encourage the client to decrease smoking.
Correct Answer: B
Rationale: Frequent moisturizers combat skin fibrosis in scleroderma. Artificial tears are for Sjögren’s, braces are unrelated, and smoking cessation is secondary.