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Exhibits

The client has received a medical diagnosis of rheumatoid arthritis (RA). The client should receive education about living and managing her condition and how to minimize disease complications.
Which education should be given to the client by the nurse? Select all that apply.

Perform aggressive weight bearing exercises.

Anticipate dry eyes and mouth; no intervention is needed.

Take hot showers to help relieve stiffness.

Observe skin for any lesions.

Watch for gastrointestinal upset with medication administration.

Discuss body image feelings with a trusted friend or therapist.

Avoid fluids, to decrease trips to the bathroom.

Prioritize rest, with short periods of activity.

Answer and Explanation

Correct Answer : C,D,E,F,H

A. Perform aggressive weight bearing exercises: Aggressive weight-bearing exercises may place too much strain on the joints, especially for someone with RA. Low-impact activities, such as swimming or walking, are generally recommended to avoid exacerbating joint damage or pain.

B. Anticipate dry eyes and mouth; no intervention is needed: While dry eyes and mouth can occur in autoimmune diseases like RA, particularly if the client has secondary Sjögren's syndrome, they should not be ignored. The nurse should advise the client to seek treatment for these symptoms, as interventions can provide relief.

C. Take hot showers to help relieve stiffness: Warm showers or baths can help reduce the stiffness and pain associated with rheumatoid arthritis (RA) by relaxing muscles and improving circulation. This can be an effective method to manage the morning stiffness that the client experiences.

D. Observe skin for any lesions: Skin lesions can be a result of certain medications or the disease process itself. RA treatment, particularly with medications like methotrexate or biologics, can increase the risk of skin issues, and regular monitoring is important for early identification.

E. Watch for gastrointestinal upset with medication administration: NSAIDs like ibuprofen, which the client is taking for pain, can cause gastrointestinal issues such as ulcers or irritation. Monitoring for these symptoms is important to avoid complications related to the medication.

F. Discuss body image feelings with a trusted friend or therapist: The chronic nature of RA, along with potential joint deformities and limitations, can impact body image. Discussing these feelings with a trusted person or therapist can help the client manage the psychological aspects of living with a chronic condition.

G. Avoid fluids, to decrease trips to the bathroom: Reducing fluid intake could lead to dehydration, which may cause other complications. The client should be encouraged to drink adequate fluids, despite more frequent trips to the bathroom, to stay properly hydrated.

H. Prioritize rest, with short periods of activity: RA can cause joint fatigue and pain. It’s important to balance periods of rest with light, non-strenuous activities to reduce stress on the joints while maintaining some level of mobility. This can help manage energy levels and minimize joint strain.

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Correct Answer is A

Explanation

A. Demonstrate to the PN how to position the client more effectively for the procedure:
The correct position for a sigmoidoscopy is the left lateral or Sims' position to allow easier access to the sigmoid colon. Demonstrating the correct position supports patient safety and provides teaching for the PN.

B. Arrange for unlicensed assistive personnel to assist the PN during the procedure: Assistance is not the issue in this scenario; the problem lies in incorrect positioning. Assigning additional help does not address the need to correct the client's position.

C. Acknowledge that the PN has positioned the client safely and correctly: The flat prone position is not appropriate for a sigmoidoscopy. Acknowledging incorrect positioning would be unsafe and potentially delay the procedure or increase the risk of injury.

D. Assume care of the client and assign the PN to the care of a different client: This is an excessive response that undermines the PN’s role. The more constructive approach is to guide and support the PN through demonstration rather than reassignment.

Correct Answer is []

Explanation

Rationale for Correct Choices:

Nephrotic Syndrome: The child’s symptoms, including edema, fatigue, increased weight despite decreased appetite, and proteinuria, point towards nephrotic syndrome. This condition involves the loss of protein (mainly albumin) in the urine, leading to edema. The laboratory result of 2+ protein in the urine and low albumin level of 2.8 g/dL are consistent with nephrotic syndrome.
Provide a low-salt diet: A low-salt diet is a key intervention in nephrotic syndrome to help manage fluid retention and edema. Sodium causes water retention, which worsens edema, and limiting salt intake can help reduce swelling and manage the symptoms effectively.
Administer albumin: Administering albumin is important in nephrotic syndrome because it helps replenish the albumin levels in the blood. Restoring the albumin levels can help reduce edema by improving osmotic pressure and preventing fluid from accumulating in the tissues.
Daily weight: Daily weight monitoring is essential to assess for changes in fluid retention. In nephrotic syndrome, fluid retention can fluctuate, and regular monitoring helps assess the effectiveness of the treatment plan and helps guide further interventions.
Abdominal girth: Monitoring abdominal girth is necessary to track the extent of fluid accumulation in the abdomen. Abdominal edema is common in nephrotic syndrome, and significant increases in girth could indicate worsening fluid retention.

Rationale for Incorrect Choices:

Type 1 diabetes: This presents with increased thirst, frequent urination, and weight loss due to elevated blood glucose levels. However, this child is experiencing weight gain despite decreased appetite and has symptoms of edema, which are not typical of diabetes.
Wilms' tumor: Wilms' tumor presents with an abdominal mass, hematuria, or pain, which is not mentioned in this case. While renal issues could cause edema, the lab results of proteinuria and low albumin suggest nephrotic syndrome rather than a malignancy like Wilms' tumor.
Hemolytic uremic syndrome: Hemolytic uremic syndrome is characterized by hemolytic anemia, thrombocytopenia, and acute kidney injury. The child does not show signs of anemia, low platelets, or kidney failure (such as elevated creatinine), which are key features of HUS.

Place the child on strict bed rest While it’s important to monitor the child closely, strict bed rest could lead to muscle weakness and decreased mobility. The focus should be on managing edema and ensuring proper fluid balance, not restricting movement.
Prepare the child for emergency surgery: Emergency surgery is not indicated for nephrotic syndrome, which is a non-surgical condition that can be managed with medications (like albumin) and lifestyle adjustments (such as a low-salt diet).
Prepare an insulin drip: An insulin drip would be appropriate for managing hyperglycemia, typically seen in diabetic emergencies. However, this child does not show any signs of diabetes or hyperglycemia. The focus is on managing nephrotic syndrome.

Lymph node size: Lymph node size is monitored in cases of infection or malignancy. In nephrotic syndrome, the primary concern is fluid retention and protein loss, not lymph node enlargement.
Bladder volume: Bladder volume monitoring is typically relevant in cases of urinary retention or other urinary tract disorders. This child’s primary concern is proteinuria and edema, which are linked to kidney function and fluid balance, rather than bladder volume.
Ketones: Monitoring ketones is generally relevant in cases of uncontrolled diabetes or prolonged fasting. However, this child is not presenting with symptoms of hyperglycemia or ketosis. Nephrotic syndrome does not typically involve ketones.

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Exhibits The client has received a medical diagnosis of rheumatoid arthritis (RA). The client should receive education about living and managing her condition and how to minimize disease complications. Which education should be given to the client by the nurse? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is setting up the equipment to assist with a sigmoidoscopy while the practical nurse (PN) positions the client in a flat prone position. Which action should the nurse implement?

Correct Answer is A

Explanation

Exhibits Complete the diagram by dragging from the choices area to specify which condition the client is most likely experiencing, two actions the nurse should take to address that condition, and two parameters the nurse should monitor to assess the client's progress.

Correct Answer is []

Explanation

Exhibits The nurse is concerned about the client's temperature. Which interventions can the nurse use to address the client's temperature? Select all that apply.

Exhibits Drag from Word Choices to complete the sentence. According to the lab values, the client has dropdownrelated to dropdownordropdown.

The nurse is demonstrating correct transfer procedures to the unlicensed assistive personnel (UAP) working on a rehabilitation unit. The UAP asks the nurse how to safely move a physically disabled client from the wheelchair to a bed. Which action should the nurse recommend?

Exhibits The client asks the diabetic nurse educator to clarify what the Registered Dietician told her about the content and timing of her meals. Which 3 responses should the diabetic nurse educator provide?

Exhibits The nurse is preparing the client's plan of care. A major component of the clients at home care is pain management. Select the 3 most important interventions the nurse can educate the client with rheumatoid arthritis (RA) about to help with pain management.

The parent of a child born with a myelomeningocele asks the nurse, "What did I do to deserve this?" Which response is most helpful?

The nurse is developing a teaching plan for a client with acute gastritis caused by drinking contaminated water. The nurse should emphasize the need to report the onset of which problem?

Exhibits

The client has received a medical diagnosis of rheumatoid arthritis (RA). The client should receive education about living and managing her condition and how to minimize disease complications.
Which education should be given to the client by the nurse? Select all that apply.