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.

Consult a dietitian to support nutrition and weight loss.

Perform fine motor activities for the client to decrease pain.

Avoid movement, as it will increase pain.

Eat a diet high in refined carbohydrates.

Apply ice packs to inflamed joints.

Facilitate paraffin wax dips to help soothe joints.

Answer and Explanation

Correct Answer : A,E,F

A. Consult a dietitian to support nutrition and weight loss: Excess weight puts added stress on joints, particularly weight-bearing joints. A dietitian can help create a balanced, anti-inflammatory diet and assist with weight loss to reduce strain on the joints and control inflammation.

B. Perform fine motor activities for the client to decrease pain: Fine motor activities may increase joint strain and discomfort in RA patients, particularly if done in excess or without adequate rest. Focus should be on rest and controlled activity.

C. Avoid movement, as it will increase pain: Complete immobilization of joints can lead to stiffness and further deterioration. While rest is important during flare-ups, gentle movement and exercises, such as range-of-motion exercises, are essential to prevent joint stiffness and preserve function.

D. Eat a diet high in refined carbohydrates: A diet high in refined carbohydrates is not beneficial for RA patients. Refined carbohydrates can increase inflammation and contribute to weight gain, which may worsen the symptoms of RA. A well-balanced, anti-inflammatory diet is recommended instead.

E. Apply ice packs to inflamed joints: Applying ice packs to inflamed joints can reduce swelling and provide relief from acute pain and inflammation. Cold therapy can help to numb the area, providing short-term relief and decreasing inflammation in affected joints for pain management in RA.

F. Facilitate paraffin wax dips to help soothe joints: Paraffin wax dips used to relieve pain and stiffness in joints affected by rheumatoid arthritis. The warm wax helps to relax muscles, increase blood flow, and reduce stiffness in the hands and wrists, providing comfort and improving joint mobility.

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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.

A. Monitor ETT markings between 22 and 26 cm at teeth line. B. Check for capillary refill of 3 seconds or less. C. Auscultate for presence of bilateral breath sounds. D. Obtain a portable chest x-ray to verify ETT location. E. Assess for symmetrical chest movement.

Correct Answer is ["C","D","E"]

Explanation

A. Monitor ETT markings between 22 and 26 cm at teeth line: While the placement marking on the ETT can be useful for initial placement, it is not the most reliable way to confirm correct positioning. ETT placement should always be verified by clinical assessment rather than relying solely on measurements.

B. Check for capillary refill of 3 seconds or less: Capillary refill is a general indicator of peripheral circulation and does not directly assess whether the ETT is properly placed in the trachea. It is not useful for confirming ETT placement.

C. Auscultate for presence of bilateral breath sounds: This is a key assessment to confirm that the ETT is properly placed. Bilateral breath sounds indicate that air is entering both lungs, suggesting that the tube is correctly positioned in the trachea and not in the esophagus.

D. Obtain a portable chest x-ray to verify ETT location: A chest x-ray is the gold standard for confirming the correct placement of the ETT. It provides an accurate visual confirmation of the tube’s position relative to the carina and the lungs.

E. Assess for symmetrical chest movement: Symmetrical chest movement is another important assessment to confirm proper ETT placement. If the ETT is correctly placed in the trachea, both sides of the chest will rise and fall equally with each breath, indicating effective ventilation.

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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.

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Naxlex Comprehensive Predictor Exams

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

A young adult is brought to the emergency department after taking a handful of drugs. The client is unresponsive, so an endotracheal tube (ETT) is inserted. How should the nurse determine if the ETT is correctly placed? Select all that apply.

Correct Answer is ["C","D","E"]

Explanation

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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.