Nokea
While working at a clinic at a summer camp, the nurse sees a camper complaining of chills and muscle aches. Upon examination, the nurse notes a circular lesion with a red border and a clear centre on the camper's right arm. Which of the following actions should the nurse take next?
- A. Palpate the abdomen.
- B. Auscultate the heart sounds.
- C. Ask the patient about recent outdoor activities.
- D. Question the patient about immunization history.
Correct Answer: C
Rationale: The patient's clinical manifestations suggest possible Lyme disease. A history of recent outdoor activities such as hikes will help confirm the diagnosis. The patient's symptoms do not suggest cardiac or abdominal problems or lack of immunization.
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The nurse is caring for a patient with an exacerbation of rheumatoid arthritis (RA) and is taking prednisone 40 mg daily. Which of these assessment data obtained by the nurse indicate that the patient is experiencing an adverse effect of the medication?
- A. The patient's blood glucose is 9.2 mmol/L.
- B. The patient has no improvement in symptoms.
- C. The patient has experienced a recent 2 kg weight loss.
- D. The patient's erythrocyte sedimentation rate (ESR) has increased.
Correct Answer: A
Rationale: Corticosteroids have the potential to cause diabetes mellitus. The finding of an elevated blood glucose reflects this adverse effect of prednisone. Corticosteroids increase appetite and lead to weight gain. An elevated ESR and no improvement in symptoms would indicate that the prednisone was not effective but would not be adverse effects of the medication.
The nurse is caring for a patient with gout and takes losartan for control of the condition. Which of the following laboratory results should the nurse plan to monitor in the patient?
- A. Blood glucose
- B. Blood pressure
- C. Erythrocyte count
- D. Lymphocyte count
Correct Answer: B
Rationale: Losartan, an angiotensin II receptor antagonist, will lower blood pressure. It does not affect blood glucose, red blood cell count (RBC), or lymphocytes.
The nurse is caring for a patient with dermatomyositis who is receiving long-term prednisone therapy. Which of the following findings is most important to report to the health care provider?
- A. The blood glucose is 6.2 mmol/L.
- B. The patient has painful hematuria.
- C. The patient has an increased appetite.
- D. Acne is noted on the back and face.
Correct Answer: B
Rationale: Corticosteroid use is associated with increased risk for infection, so the nurse should report the urinary tract symptoms immediately to the health care provider. The increase in blood glucose, increased appetite, and acne also are adverse effects of corticosteroid use, but do not need diagnosis and treatment as rapidly as the probable urinary tract infection.
The nurse is caring for a patient who has rheumatoid arthritis (RA) and is prescribed anakinra. Which of the following information should the nurse include when teaching the patient about this drug?
- A. Self-administration of subcutaneous injections
- B. Take the medication with at least 240 mL of fluid
- C. Avoid concurrently taking Aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs)
- D. Symptoms of gastrointestinal (GI) irritation or bleeding
Correct Answer: A
Rationale: Anakinra is administered by subcutaneous injection. GI bleeding is not an adverse effect of this medication. Because the medication is injected, instructions to take it with 240 mL of fluid would not be appropriate. The patient is likely to be concurrently taking Aspirin or NSAIDs, and these should not be discontinued.
The nurse is caring for a young adult patient suspected of having septic arthritis, is hospitalized with a fever and red, hot, painful knees. Which of the following information obtained during the nursing history indicates a risk factor for septic arthritis?
- A. Has a parent who has reactive arthritis.
- B. Is sexually active and has multiple partners.
- C. Recently returned from a trip to South America.
- D. Had several sports-related knee injuries as a teenager.
Correct Answer: B
Rationale: Neisseria gonorrhoeae is the most common cause for septic arthritis in sexually active young adults. The other information does not point to any risk for septic arthritis.