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Exhibits

Which information from the history and physical, nurses' note, and flow sheet requires further evaluation? Select all that apply.

Occupation of legal secretary

Stiffness in hands for 3 months

Radial and pedal pulses 2+

Pain in bilateral hands and wrists

History of asthma using albuterol inhaler PRN

Capillary refill 2 seconds

Body mass index (BMI) of 31 kg/m2

Client's hobbies

Answer and Explanation

Correct Answer : A,B,D,G,H

A. Occupation of legal secretary: The client works as a legal secretary, which may involve extensive typing or repetitive hand movements. This can contribute to musculoskeletal stress or strain, potentially exacerbating symptoms like pain and stiffness in the hands.

B. Stiffness in hands for 3 months: The client reports stiffness in both hands and wrists for the past 3 months, which could suggest an inflammatory arthritis such as rheumatoid arthritis (RA). This warrants further evaluation, especially given her family history of arthritis.

C. Radial and pedal pulses 2+: A rating of 2+ for radial and pedal pulses is normal, indicating no circulation issues, and does not need further evaluation.

D. Pain in bilateral hands and wrists: Persistent, symmetrical pain in the hands and wrists, particularly with palpation, may indicate a condition like rheumatoid arthritis. This symptom, in combination with morning stiffness, needs further investigation.

E. History of asthma using albuterol inhaler PRN: The client's history of well-controlled asthma, managed with an albuterol inhaler as needed for exacerbations, does not directly relate to her current presentation of hand pain and stiffness.

F. Capillary refill 2 seconds: A capillary refill time of 2 seconds is within the normal range, indicating adequate peripheral perfusion. This finding suggests that there are no immediate circulatory issues contributing to her hand pain and stiffness and does not require further evaluation.

G. Body mass index (BMI) of 31 kg/m²: A BMI of 31 falls within the obese range, which can increase the risk for musculoskeletal issues and other chronic conditions. This factor should be evaluated further, as obesity may affect joint health.

H. Client's hobbies: The client enjoys hobbies like gardening and crocheting, which involve repetitive hand movements. These activities could exacerbate the pain and stiffness in her hands, making it important to evaluate whether these hobbies are contributing to her symptoms.

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Correct Answer is ["A","D","E","G"]

Explanation

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.

Correct Answer is []

Explanation

Rationale for Correct Choices:

Myocardial infarct (MI): The client presents with chest pain described as pressure and tightness, which worsens over time. The ECG shows ST depression, a common sign of ischemia. This combined with the risk factors and vital signs support myocardial infarction.
Prepare client for possible percutaneous coronary intervention: If a myocardial infarction is suspected, preparing the client for PCI is critical. PCI is used to treat blockages in the coronary arteries, which is essential for restoring blood flow and minimizing myocardial damage.
Educate on nitroglycerin administration: Nitroglycerin helps alleviate chest pain by relaxing coronary arteries, reducing heart workload, and improving blood flow. It is used in MI management to relieve symptoms and reduce ischemia.
Electrocardiogram (ECG): Continuous ECG monitoring is essential to assess the progression of any arrhythmias or ischemic changes, which are common during an MI. It allows real-time identification of worsening conditions.
Chest pain: Monitoring chest pain closely helps evaluate the effectiveness of treatment and determine whether ischemia persists or resolves. Pain relief indicates that interventions are successful.

Rationale for Incorrect Choices:

Atrial fibrillation: While atrial fibrillation can cause chest discomfort, the patient’s clinical presentation, including ECG findings and risk factors, is more consistent with an MI. Atrial fibrillation usually presents with irregular heartbeats rather than persistent chest pressure.
Congestive heart failure: The current presentation, including chest pain, ECG changes, and pain unrelieved by rest, points to a myocardial infarction rather than congestive heart failure. There are no signs of fluid overload or symptoms associated with heart failure in this scenario.
New onset angina: While the client may experience angina, the unrelieved chest pain lasting for over 30 minutes and the severity of the symptoms suggest a myocardial infarction rather than just new onset angina, which typically resolves with rest.
Begin chest compressions: Chest compressions are necessary only in cases of cardiac arrest. While this client is experiencing chest pain and signs of an MI, there is no indication of cardiac arrest, so chest compressions are not appropriate at this point.
Consult physical therapy: Physical therapy is not immediately needed for the acute management of myocardial infarction. The priority is stabilizing the patient's cardiac status and addressing the ischemia, not physical rehabilitation.
Conduct a nutritional history: While a nutritional history is important for long-term heart disease management, it is not an immediate concern during an acute MI episode. The focus should be on stabilizing the patient and addressing the immediate cardiovascular issues.

Lung sounds: Lung sounds are not directly relevant to this patient's current condition. While they may be important for detecting complications like pulmonary edema, they are not a priority when assessing for an acute MI.
Pedal pulses: Pedal pulses can be useful in assessing peripheral circulation but are not a priority in the management of MI unless signs of shock or poor circulation are noted.
Intake and output: While monitoring intake and output is important for fluid balance, it is not the immediate focus for managing this patient’s acute MI. The focus should be on cardiac parameters and symptom relief, such as monitoring chest pain and ECG changes.

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Exhibits Which information from the history and physical, nurses' note, and flow sheet requires further evaluation? Select all that apply.

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Naxlex Comprehensive Predictor Exams

Correct Answer is ["A","D","E","G"]

Explanation

Correct Answer is []

Explanation

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Exhibits

Which information from the history and physical, nurses' note, and flow sheet requires further evaluation? Select all that apply.