A 51-year-old woman with Crohn's disease who is taking infliximab (Remicade) calls the nurse in the outpatient clinic about new symptoms. Which symptom is most important to communicate to the health care provider?
Joint pain
Fever
Headache
Nausea
The Correct Answer is B
Choice A reason: Joint pain (arthralgia) is a common extraintestinal manifestation of Crohn's disease and can also be a side effect of biologic therapy. While uncomfortable and worth noting, it is not typically an acute life-threatening emergency. It does not carry the same immediate clinical urgency as a sign of systemic infection in an immunocompromised patient.
Choice B reason: Infliximab is a tumor necrosis factor (TNF) inhibitor that significantly suppresses the immune system. Patients taking biologics are at high risk for serious opportunistic infections, including tuberculosis and sepsis. A fever may be the only early sign of a life-threatening infection, requiring immediate cessation of the drug and medical evaluation.
Choice C reason: Headache is a frequently reported side effect of infliximab infusions. While it should be monitored, it is generally considered a minor adverse effect unless it is exceptionally severe or accompanied by neurological deficits. It does not indicate the high level of physiological risk that a fever does in an immunosuppressed individual.
Choice D reason: Nausea is another common side effect associated with many medications, including biologics for inflammatory bowel disease. While it affects the client's quality of life and nutritional status, it is not an indicator of an acute, high-priority safety concern like a potential systemic infection or a severe hypersensitivity reaction.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: While ulcerative colitis can have periods of activity and quiet, this "skip" pattern or intermittent nature is more classically associated with Crohn's disease. Ulcerative colitis is characterized by continuous inflammation starting from the rectum and moving proximally up the colon, rather than having healthy tissue between diseased segments.
Choice B reason: Hematochezia (bloody stool) is one of the hallmark symptoms of ulcerative colitis. Because the disease involves continuous ulceration and inflammation of the colonic mucosa, clients almost always present with blood in their diarrhea. An absence of blood would be highly uncharacteristic for this specific diagnosis.
Choice C reason: Ulcerative colitis is a chronic inflammatory disease that primarily and consistently affects the mucosa of the rectum and the large intestine. In almost 95% of cases, the rectum is involved, and the inflammation spreads continuously from there. This is a key diagnostic differentiator from Crohn's disease, which can affect any part of the GI tract.
Choice D reason: While severe diarrhea is a symptom of ulcerative colitis, it is not its most defining "characteristic" in a comparative medical context, as many gastrointestinal conditions (including Crohn's disease and infectious enteritis) cause severe diarrhea. The anatomical pattern and the specific mucosal involvement are what define the disease pathologically.
Correct Answer is A
Explanation
Choice A reason: Calcium acetate is a phosphate binder. In clients with CKD, the kidneys cannot excrete phosphorus, leading to hyperphosphatemia. Phosphate binders are taken with meals to bind phosphorus from food in the intestinal tract, forming an insoluble complex that is excreted in the feces, thereby reducing systemic absorption and serum levels.
Choice B reason: Doxycycline is a broad-spectrum tetracycline antibiotic. It is used to treat various bacterial infections and has no role in the management of phosphorus or electrolyte imbalances in chronic kidney disease. In fact, some tetracyclines must be used with caution in renal impairment due to potential nephrotoxicity or accumulation.
Choice C reason: Lisinopril is an ACE inhibitor used to manage hypertension and provide renal protection by reducing intraglomerular pressure in the early stages of CKD. While it is a common medication for these patients, it does not lower serum phosphorus levels and can actually cause a risk of hyperkalemia in advanced renal failure.
Choice D reason: Magnesium sulfate is an electrolyte replacement or anticonvulsant. It is generally avoided or used with extreme caution in CKD patients because the kidneys are responsible for magnesium excretion. Administering it could lead to magnesium toxicity (hypermagnesemia), and it has no clinical utility in the reduction of serum phosphorus.
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