Exhibits
The nurse evaluates the client and the flow sheet.
Click to highlight the findings that indicate the client is progressing as expected.
The client presents to the office for reevaluation of rheumatoid arthritis after methotrexate 25 mg PO weekly was started at the last visit. The client reports she has been balancing periods of activity with rest. She recently attended a large family wedding and became fatigued quickly. She has continued to garden, and read, but crocheting is too painful. She is tolerating weekly medication without side effects. She describes pain as 1 to 2 on a 0 to 10 pain scale in bilateral hands. She has noticed "heartburn" about an hour after using ibuprofen for pain relief. The client is pleased with the improvements.
The client reports she has been balancing periods of activity with rest
She recently attended a large family wedding and became fatigued quickly
She has continued to garden, and read, but crocheting is too painful
She is tolerating weekly medication without side effects
She describes pain as 1 to 2 on a 0 to 10 pain scale in bilateral hands
She has noticed "heartburn" about an hour after using ibuprofen for pain relief
The client is pleased with the improvements
The Correct Answer is ["A","D","E","G"]
Rationale for Correct Findings:
- Balancing periods of activity with rest: This indicates effective self-management and understanding of a key principle in managing rheumatoid arthritis. Maintaining this balance helps prevent overexertion and joint flares while preserving mobility and function.
- Client reports pain as 1 to 2 on a 0 to 10 pain scale in bilateral hands: The reduction in pain from a previous score of 3 to 1-2 indicates a positive response to treatment. Pain reduction is a key marker of progress in managing rheumatoid arthritis, especially with the initiation of methotrexate.
- She is tolerating weekly medication without side effects: Tolerating methotrexate without side effects is a positive outcome. Methotrexate is a cornerstone treatment for rheumatoid arthritis, and its ability to be well-tolerated suggests good disease control.
- The client is pleased with the improvements: The client’s satisfaction with her treatment and the improvements in her condition demonstrate effective management of her rheumatoid arthritis and a positive response to the prescribed interventions.
Rationale for Incorrect Findings:
- She has continued to garden, but crocheting is too painful: The client’s inability to crochet due to pain suggests that joint function is still limited in certain fine motor activities. This shows that while some improvement has been made, the disease still affects specific functions.
- She recently attended a large family wedding and became fatigued quickly: Fatigue is common in RA and suggests that the client’s energy levels still need better management. Overexertion could indicate a need for better pacing between rest and activity to avoid exacerbating symptoms.
- She has noticed "heartburn" about an hour after using ibuprofen for pain relief: Heartburn is a common side effect of NSAIDs like ibuprofen, which could lead to gastrointestinal irritation. This issue requires attention, as it could progress to more serious gastrointestinal complications.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. "Tomorrow I will talk to that nurse about how you were treated last night": This may reinforce the client's black-and-white thinking by validating their perception without exploring the situation. It could also create further conflict or confusion.
B. "I am happy that you are getting better and will be able to go home": This response doesn't address the client's concern and does not help manage the client's dichotomous thinking. It is important to validate the client's feelings and address the issue at hand.
C. "What did the night nurse do that makes you think the nurse is aloof?": This response explores the client's perception in a non-judgmental manner. It encourages the client to reflect on the situation and provides an opportunity for the nurse to gain insight into the client's thought process, helping to address the dichotomous thinking.
D. "I am glad you like me. Which nurse was acting aloof to you?": This response may reinforce the client's idealization of the current nurse and devaluation of the night nurse. It does not address the underlying issue of the client's perception and could encourage further splitting.
Correct Answer is A
Explanation
A. Avoid straining at stool, bending, or lifting heavy objects: These activities can increase intraocular pressure and disrupt healing of the surgical site after cataract extraction. The client should be taught to avoid anything that could strain the eye and risk complications like hemorrhage or wound dehiscence.
B. Irrigate conjunctiva with ophthalmic saline prior to instilling antibiotic ointment:
Routine irrigation is not required and may introduce additional risk. Clients are instructed on proper hand hygiene and drop instillation rather than conjunctival irrigation.
C. Do not read without direct lighting for 6 weeks: While good lighting helps reduce eye strain, reading in lower light does not delay healing after cataract surgery. This instruction is unnecessary and could limit the client’s ability to resume normal activities.
D. Limit exposure to sunlight during the first 2 weeks when the cornea is healing: Although bright light can be uncomfortable post-surgery, wearing sunglasses typically offers sufficient protection. There is no requirement to restrict sunlight exposure completely.
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