A client with a diagnosis of multiple sclerosis is scheduled to receive plasmapheresis treatments. A nurse explains to the client's spouse that the purpose of plasmapheresis is to:

infuse lipoproteins to restore the myelin sheath.

remove excess fluid from the blood stream.

restore protein levels in the blood.

remove circulating antibodies from the blood stream.

Answer and Explanation

The Correct Answer is D

A) Infuse lipoproteins to restore the myelin sheath:
Multiple sclerosis (MS) is an autoimmune disease where the immune system attacks the myelin sheath around nerve fibers. Plasmapheresis does not work by infusing lipoproteins to restore the myelin sheath. The treatment's primary goal is to remove harmful substances from the blood that may be contributing to the autoimmune attack, particularly antibodies that target the nervous system, not by restoring the myelin itself.

B) Remove excess fluid from the bloodstream:
Plasmapheresis is a process used to remove certain substances from the plasma, including antibodies and immune complexes that might be exacerbating an autoimmune condition like MS. If the goal were to remove excess fluid, the treatment would be more akin to dialysis or a fluid management procedure, but this is not the case with plasmapheresis.

C) Restore protein levels in the blood:
While plasmapheresis can sometimes lead to a temporary decrease in protein levels due to the removal of plasma, this is not its primary purpose. The primary goal of plasmapheresis in the context of multiple sclerosis is to remove circulating antibodies and other immune-related substances.

D) Remove circulating antibodies from the bloodstream:
Plasmapheresis works by removing circulating antibodies from the bloodstream. In multiple sclerosis, the immune system mistakenly targets the myelin sheath, and plasmapheresis helps to remove the antibodies responsible for this autoimmune response. This can provide temporary relief of symptoms during acute flare-ups of MS by reducing the immune system's attack on the nervous system.

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Correct Answer is A

Explanation

A) Digoxin:
The client’s symptoms of confusion, vision disturbances (such as yellow halos around lights), and anorexia are all classic signs of digoxin toxicity. Digoxin, a cardiac glycoside, is commonly used in the treatment of heart failure and atrial fibrillation. However, it has a narrow therapeutic index, meaning that even slightly elevated blood levels can lead to toxicity. Other common symptoms of digoxin toxicity include bradycardia (which the client is also experiencing with a pulse of 53 bpm), nausea, and vomiting.

B) Diltiazem:
Diltiazem is a calcium channel blocker used to treat hypertension, angina, and atrial fibrillation. While it can cause bradycardia (as evidenced by the client’s pulse of 53 bpm), vision disturbances and anorexia are not typical side effects of this medication. More common side effects include hypotension, edema, and constipation.

C) Propranolol:
Propranolol is a beta-blocker used to treat hypertension, arrhythmias, and angina, as well as to prevent migraines. Bradycardia is a known side effect of beta-blockers, but vision disturbances and anorexia are not typical of propranolol. Moreover, propranolol can cause hypotension and fatigue but would not be as likely to cause the specific symptoms of confusion and vision changes seen in this client.

D) Captopril:
Captopril is an ACE inhibitor commonly used to treat hypertension and heart failure. Common side effects include hypotension, dizziness, and hyperkalemia, but vision disturbances and anorexia are not typical side effects of captopril. The symptoms the client is experiencing are more specific to digoxin toxicity than to captopril's side effects.

A. Hyperglycemia B. Hyperkalemia C. Fluid retention D. Gl distress E. Hypotension

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

Explanation

A) Hyperglycemia:
Prednisone, a glucocorticoid, can increase blood glucose levels by stimulating the liver to produce more glucose and decreasing the effectiveness of insulin. This can lead to hyperglycemia, particularly in individuals who are predisposed to diabetes or glucose intolerance. Therefore, monitoring blood glucose levels is important during prednisone therapy, especially in clients with a history of diabetes or those at risk for developing it.

B) Hyperkalemia:
Prednisone and other corticosteroids typically decrease potassium levels rather than increase them. This occurs because corticosteroids can promote the excretion of potassium in the kidneys. Hyperkalemia is not a common side effect of prednisone therapy. In fact, hypokalemia (low potassium) is more likely to occur, so this is not a concern for clients receiving prednisone.

C) Fluid retention:
One of the common side effects of prednisone is fluid retention due to its effect on the kidneys and the way it can increase sodium reabsorption. This can lead to edema (swelling), especially in the lower extremities, and could also contribute to an increase in blood pressure. Clients taking prednisone, particularly in higher doses or for extended periods, should be monitored for signs of fluid retention and hypertension.

D) GI distress:
Gastrointestinal distress, including gastritis, ulcers, or nausea, is a common side effect of prednisone and other corticosteroids. The risk is higher if the medication is taken on an empty stomach or at high doses. To minimize this, prednisone is typically taken with food or milk, and clients are monitored for signs of GI irritation.

E) Hypotension:
Prednisone can cause increased blood pressure due to fluid retention and the resulting increased blood volume. It can also affect the balance of sodium and potassium, contributing to hypertension rather than hypotension. Hypotension is not a typical side effect of prednisone therapy, and the nurse should be vigilant for signs of high blood pressure rather than low.

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A client with a diagnosis of multiple sclerosis is scheduled to receive plasmapheresis treatments. A nurse explains to the client's spouse that the purpose of plasmapheresis is to:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is A

Explanation

A client with COPD exacerbation has been ordered oral prednisone to be tapered over two weeks. Which of the following side effects does the nurse recognize could occur during prednisone therapy? [Select all that apply.]

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

Explanation

A nurse is assessing a client who has been recently diagnosed with Bell's palsy. Which of the following findings should the nurse expect? [Select all that apply.]

A client with the rhythm below has been admitted into the cardiac icu. What assessment finding does the nurse expect to find in this client?

A patient taking Digoxin is experiencing severe bradycardia, nausea and vomiting. A lab draw shows that their Digoxin level is 4 ng/mi (0.8-2.0 ng/ml). What management does the nurse anticipate the physician to order? Select all that apply.

A nurse instructs a 60-year-old client diagnosed with asthma about using a peak expiratory flow meter. Which immediate action should the nurse recommend to the client that obtains a reading of 82% on their peak flow meter?

A senior nurse is providing instructions to a newly hired nurse about caring for clients who are receiving diuretic therapy to treat heart failure. The senior nurse should explain that which of the following medications puts clients at risk for both hyperkalemia and hyponatremia?

A nurse is teaching a client who has angina pectoris about starting therapy with nitroglycerin tablets. The nurse should include which of the following instructions regarding how to take the medication?