Nokea
The nurse on an inpatient rheumatology unit receives a hand-off report on a client with an acute exacerbation of systemic lupus erythematosus (SLE). Which reported laboratory value requires the nurse to assess the client further?
- A. Creatinine: 3.9 mg/dL
- B. Red blood cell count: 5.2 million/µL
- C. White blood cell count: 4000/µL
- D. Platelet count: 200,000/µL
Correct Answer: A
Rationale: Lupus nephritis is the leading cause of death in clients with SLE. The creatinine level is very high and the nurse needs to perform further assessments related to this finding. The other laboratory values are normal.
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A client has been diagnosed with fibromyalgia syndrome but does not want to take the prescribed medication. What nonpharmacological measures can the nurse suggest to help manage this condition? (Select all that apply.)
- A. Acupuncture
- B. Breathing exercises
- C. Supplements
- D. Tai chi
- E. Vigorous aerobics
Correct Answer: A,B,D
Rationale: There are many nonpharmacologic means for controlling the symptoms of fibromyalgia, including acupuncture, breathing exercises, and tai chi. Vigorous aerobics may exacerbate symptoms, and supplements are not generally recommended without specific deficiencies.
A nurse is teaching a client with rheumatoid arthritis (RA) who is prescribed etanercept (Enbrel). What information is most important for the nurse to teach this client?
- A. Administer the medication via subcutaneous injection twice a week
- B. Use heat on the injection site to reduce pain
- C. Avoid large crowds or people who are ill
- D. Monitor for signs of infection daily
Correct Answer: A
Rationale: Etanercept is given as a subcutaneous injection twice a week. The nurse should teach the client how to self-administer the medication. The other options are not appropriate for etanercept.
A home health care nurse is visiting a client discharged home after a hip replacement. The client is still using a walker. What safety precautions can the nurse recommend to the client? (Select all that apply.)
- A. Buy and install an elevated toilet seat
- B. Install grab bars in the shower and by the toilet
- C. Step into the bathtub with the affected leg first
- D. Remove throw rugs throughout the house
- E. Use a shower chair
Correct Answer: A,B,D,E
Rationale: Buying and installing an elevated toilet seat, installing grab bars, removing throw rugs, and using a shower chair will all promote safety for this client. The client is still on partial weight-bearing, so stepping into the bathtub with the affected leg first is not appropriate.
A client is on the postoperative unit after a total hip replacement. The client reports a sudden onset of shortness of breath, chest pain, and coughing. What action by the nurse is best?
- A. Assess neurovascular status of both legs
- B. Elevate the affected leg and apply ice
- C. Prepare to administer pain medication
- D. Try to place the affected leg in abduction
Correct Answer: A
Rationale: This client has manifestations of hip dislocation, a critical complication of this surgery. Hip dislocation can cause neurovascular compromise. The nurse should assess neurovascular status, comparing both legs. The nurse should not try to move the extremity to elevate or abduct it. Pain medication may be administered if possible, but first the nurse should thoroughly assess this client.
A nurse works in the rheumatology clinic and sees clients with rheumatoid arthritis (RA). Which client should the nurse see first?
- A. Client who reports jaw pain when eating
- B. Client with a red, hot, swollen right wrist
- C. Client who has a puffy-looking area behind the knee
- D. Client with a worse joint deformity since the last visit
Correct Answer: B
Rationale: All of the options are possible manifestations of RA. However, the presence of one joint that is much redder, hotter, or more swollen than other joints may indicate infection. The nurse needs to see this client first.