Nokea
The nurse is caring for a client with myasthenia gravis who is six hours postoperative following a thymectomy. Which item should the nurse have at the bedside?
- A. Calcium gluconate
- B. Bag-valve mask
- C. Tracheostomy kit
- D. Atropine sulfate
Correct Answer: B
Rationale: Myasthenia gravis can cause respiratory muscle weakness, and post-thymectomy risks respiratory compromise. A bag-valve mask is critical for emergency ventilation. Calcium gluconate, tracheostomy kits, and atropine are not directly related.
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The nurse is caring for a 41-year-old female in the outpatient clinic
Item 1 of 1
• Progress Note
1300:
• Client presenting for the initial dose of etanercept following the diagnosis of rheumatoid arthritis.
• The client reported joint pain in the hands not improving with acetaminophen.
• Will prescribe better pain control and follow up in six weeks.
• Physician Orders
• Etanercept 50 mg SubQ every week
• Naproxen 500 mg PO Daily, as needed for pain
The nurse prepares to administer the prescribed etanercept.Complete the sentences below by selecting the appropriate option:The nurse should instruct the client that the prescribed etanercept
--------------------------Prior to the first dose, the nurse should ensure the client has had a----------------------After administering the medication, the nurse should----------------------
- A. raises the blood glucose
- B. increases the risk for infection
- C. causes weight gain.
- D. fasting blood glucose
- E. negative purified protein derivative (PPD) test
- F. baseline lipid panel.
- G. assess for an injection site reaction.
Correct Answer: B,E,G
Rationale: Etanercept is a tumor necrosis factor (TNF) blocking agent used to treat autoimmune disorders such as psoriasis or rheumatoid arthritis (RA). This medication increases the client's risk of infection, requiring baseline testing for TB, such as a PPD. If the client has latent TB, it may be activated again. Etanercept does not cause weight gain or raise blood glucose. This would be true if the client were prescribed a corticosteroid which may be used in exacerbations of RA. A lipid panel has no relevance to etanercept. Etanercept is administered subcutaneously at a 45 to a 90-degree angle. This medication is not administered in the deltoid; this would be appropriate for an intramuscular injection. Aspiration for subcutaneous injections is unnecessary as piercing a blood vessel is rare. The most common adverse effect of this medication is injection site reaction (redness, pain, discomfort). The area should not be rubbed or massaged as it could worsen the injection site reaction.
While training a new RN in the emergency department, the nurse attends to a client with Guillain-Barre Syndrome. The new RN asks what may have caused this condition. Which of the following occurrences in the patient's history is most likely a contributing factor?
- A. A spinal cord injury at age 12
- B. An upper respiratory infection about a month ago
- C. Hydrocephaly as an infant
- D. A joint injury as a teenager
Correct Answer: B
Rationale: Guillain-Barre Syndrome is often triggered by a recent infection, commonly an upper respiratory infection, leading to an autoimmune response against peripheral nerves. Spinal cord injury, hydrocephaly, and joint injury are unrelated.
The nurse reviews newly prescribed medications from the primary healthcare provider (PHCP). The nurse understands that the prescribed etanercept is intended to treat which condition?
- A. Osteoarthritis
- B. Diabetes mellitus
- C. Infective endocarditis (IE)
- D. Rheumatoid arthritis
Correct Answer: D
Rationale: Etanercept is a tumor necrosis factor (TNF) inhibitor used to treat autoimmune conditions like rheumatoid arthritis by reducing inflammation and joint damage. Osteoarthritis is not autoimmune, diabetes mellitus affects glucose metabolism, and infective endocarditis is a bacterial infection, none of which are treated with etanercept.
The nurse educates a client about the application of a plaster cast to a fractured radius. Which of the following statements by the client would require follow-up?
- A. If my arm feels itchy, I can use a hair dryer on the cool setting for relief.'
- B. I can reduce my arm's swelling by elevating it with a pillow.'
- C. I should be okay to shower with my cast.'
- D. It will be normal for me to feel heat after the cast is applied.'
Correct Answer: C
Rationale: Showering with a plaster cast risks wetting it, leading to breakdown or infection, requiring follow-up. Cool air for itching, elevation for swelling, and initial heat from cast setting are appropriate.
The nurse is conducting a community health fair. Which of the following clients is at the greatest risk of developing osteoporosis?
- A. 27-year-old woman who jogs three times a week and drinks red wine daily
- B. 60-year-old woman who smokes cigarettes and just recently stopped drinking alcohol
- C. 51-year-old man who suffers from alcoholism and recently stopped smoking
- D. 25-year-old man with asthma who takes inhaled corticosteroids
Correct Answer: B
Rationale: The 60-year-old woman who smokes has the greatest osteoporosis risk due to age, smoking (reduces bone density), and likely post-menopausal status. Jogging, male gender, and younger age lower risk in others.